Cancer Care Centers of South Texas

Patients & Family Members

The physicians at Cancer Care Centers of South Texas are available for patient consultations including second opinions. They will help you evaluate your diagnosis and treatment options, including a personalized treatment plan.

Find a physician at a location close to you.

Referring Physicians

Referring physicians can access a fax referral form that can be faxed to the desired location, with the new patient information.  Our new patient coordinators will contact the patient and set up their first appointment.

View our list of locations to access the forms for each.

Antonio Santillan-Gomez, MD, the gynecologic oncologist at Cancer Care Centers of South Texas, has integrated the advanced da Vinci® robotic system into our minimally invasive surgery options. Developed by NASA for the use of robotic arms in space, the da Vinci’s robotic micro-instruments translate the precise movements of the surgeon’s hands while filtering out even the slightest tremors. High-definition, scaled 3-D imaging allows for optimum viewing and manipulation of sensitive nerves and tissues. All of this gives the surgeon unmatched precision and control— using only a few small incisions.

Potential advantages for patients include:

- Shorter hospital stays
- Less pain and scarring
- Faster recovery
- Less risk of infection

*Photo ®Intuitive Surgical, Inc.

Treatment for idiopathic thrombocytopenic purpura (ITP) is based on how much and how often you’re bleeding and your platelet count. In some cases, treatment may not be needed.  Medicines often are used as the first course of treatment. Treatments used for children and adults are similar.  Adults with ITP who have very low platelet counts or problems with bleeding often are treated.  Adults who have milder cases of ITP may not need any treatment, other than watching their symptoms and platelet counts.

There are two types of ITP: acute (temporary or short-term) and chronic (long-lasting).

• Acute ITP generally lasts less than 6 months. It mainly occurs in children, both boys and girls, and is the most common type of ITP. Acute ITP often occurs after an infection caused by a virus.
• Chronic ITP is long-lasting (6 months or longer) and mostly affects adults. However, some teenagers and children can get this type of ITP. Chronic ITP affects women 2 to 3 times more often than men.

People who have ITP often have purple bruises that appear on the skin or on the mucous membranes (for example, in the mouth). The bruises mean that bleeding has occurred in small blood vessels under the skin.   A person who has ITP also may have bleeding that results in tiny red or purple dots on the skin. These pinpoint-sized dots are called petechiae.  Petechiae may look like a rash. Bleeding under the skin causes the purple, brown, and red color of the petechiae and purpura.

People who have ITP also may have nosebleeds, bleeding from the gums when they have dental work done, or other bleeding that's hard to stop.  Women who have ITP may have menstrual bleeding that's heavier than usual.

Idiopathic thrombocytopenic purpura (ITP) is a bleeding condition in which the blood doesn't clot as it should. This is due to a low number of blood cell fragments called platelets.  Platelets also are called thrombocytes which are made in your bone marrow along with other kinds of blood cells. Platelets stick together (clot) to seal small cuts or breaks on blood vessel walls and stop bleeding.  "Idiopathic" means that the cause of the condition isn't known. "Thrombocytopenic" means there's a lower than normal number of platelets in the blood. "Purpura" refers to purple bruises caused by bleeding under the skin.

**All information about ITP is provided by the National Heart, Lung, and Blood Institute as a part of the National Institutes of Health and the U.S. Department of Health and Human Services

Helpful downloadable forms:

Your Contact Information

Medication Information Sheet

Calendar and Symptom Log

The American Cancer Society (ACS:  www.cancer.org) provides breast prosthesis and wigs to patients in need, free of charge.  To find your local ACS office, please visit their website and enter your zip code.  Please inquire to you local ACS office to learn more about this assistance.

American Cancer Society Resource Room at Cancer Care Centers of South Texas in Northeast San Antonio is staffed with an ACS volunteer every Tuesday to provide all patients with breast prosthesis, bras and wigs:

2130 NE Loop 410, Suite 100
San Antonio, TX  78217
210-656-7177

The American Cancer Society (ACS:  www.cancer.org) provides transportation and housing assistance to patients free of charge.  To find your local ACS office, please visit their website and enter your zip code.  Please inquire to you local ACS office to learn more about this assistance.

CancerCare (www.cancercare.org) offers educational workshops that are free of charge to patients, family members and caregivers. These interactive, educational workshops, lead by leading oncology experts, provide information about cancer, cancer-related issues and are available to anyone by telephone.  For more information please see the CancerCare website.

Cancer doesn’t end when your treatments are over. Adjustments back into everyday life can be emotionally, physically and mentally challenging. The Life Beyond Cancer Foundation offers programs, including the Life Beyond Cancer Retreat, to help meet the unique needs of cancer survivors. These special programs are designed to help patients rekindle their spirits and experience a fulfilling life beyond their diagnosis.

The 2010 Life Beyond Cancer Retreat will be held at Lakeway Resort in beautiful Austin, TX – November 18-21.  This popular event fills up quickly.

Cancer Care Centers of South Texas is affiliated with US Oncology and the Life Beyond Cancer Foundation.  Please see the LIfe Beyond Cancer Foundation website for more information about this event.

Cancer Care Centers of South Texas offers three monthly Nutrition Seminars lead by dietician, Barbra Swanson, ND, LD, RD.  Dr. Swanson holds a doctorate in Naturopathy and is a licensed, registered dietician.  These seminars are free of charge and open to all patients, caregivers and the public.  Please see our Calendar of Events for more information about dates, times and locations.

Upcoming monthly topics:

July--Healthy Red, White and Blue!

August--Hot Summer Days:  Stay Cool With Foods

September--Man Up:  Learn How to Protect Your Prostate

October--Breast Health:  Reduce Your Risk of Cancer

November--In Appreciation:  Nutrition Toolkit for the Caregiver

December--Eating Healthy During the Busiest Time of the Year

Cancer Support Group

Our Support Group is lead by Eleanor Komet, PhD and is held every Tuesday from 11:30 a.m. to 12:30 a.m. in the lobby of our cancer center at 4411 Medical Drive, Suite 100, San Antonio, TX  78229.  Participation in our Support Group is free of charge.  For more information please call 210-595-5300.

Cancer Care Centers of South Texas is affiliated with the Anticoagulation Clinics of North America (ACNA).  ACNA is a complete anticoagulation and thrombosis management service providing high-quality, efficient care to patients receiving anticoagulation with warfarin (Coumadin) and antithrombotic medications (blood thinners and platelet inhibitors). 

Services offered include both out-patient and in-hospital management of anticoagulant medications.  In addition, ACNA offers a comprehensive out-patient treatment program for Deep Vein Thrombosis (DVT) and comprehensive evaluation and management of patients with thrombotic disorders.  Most patients with deep vein thrombosis can now be evaluated and treated in our office without needing a hospital admission.

For extensive information about our anticoagulation and thrombosis management service, please see our complete website for the Anticoagulation Clinics of North America. 

 

The types of leukemia also can be grouped based on the type of white blood cell that is affected. Leukemia can start in lymphoid cells or myeloid cells.  Leukemia that affects lymphoid cells is called lymphoid, lymphocytic, or lymphoblastic leukemia.  Leukemia that affects myeloid cells is called myeloid, myelogenous, or myeloblastic leukemia.

• Chronic lymphocytic leukemia (CLL): CLL affects lymphoid cells and usually grows slowly. It accounts for more than 15,000 new cases of leukemia each year. Most often, people diagnosed with the disease are over age 55. It almost never affects children.
• Chronic myeloid leukemia (CML): CML affects myeloid cells and usually grows slowly at first. It accounts for nearly 5,000 new cases of leukemia each year. It mainly affects adults.
• Acute lymphocytic (lymphoblastic) leukemia (ALL): ALL affects lymphoid cells and grows quickly. It accounts for more than 5,000 new cases of leukemia each year. ALL is the most common type of leukemia in young children. It also affects adults.
• Acute myeloid leukemia (AML): AML affects myeloid cells and grows quickly. It accounts for more than 13,000 new cases of leukemia each year. It occurs in both adults and children.
• Hairy Cell Leukemia: A rare type of leukemia in which abnormal B-lymphocytes (a type of white blood cell) are present in the bone marrow, spleen, and peripheral blood. When viewed under a microscope, these cells appear to be covered with tiny hair-like projections.
   

Tests that examine the blood and bone marrow are used to detect (find) and diagnose myelodysplastic syndromes.  The following tests and procedures may be used:

Physical exam and history:  An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

Complete blood count (CBC) with differential: A procedure in which a sample of blood is drawn and checked for the following:

• The number of red blood cells and platelets
• The number and type of white blood cells
• The amount of hemoglobin (the protein that carries oxygen) in the red blood cells
• The portion of the blood sample made up of red blood cells 

Complete blood count (CBC). Blood is collected by inserting a needle into a vein and allowing the blood to flow into a tube. The blood sample is sent to the laboratory and the red blood cells, white blood cells, and platelets are counted. The CBC is used to test for, diagnose, and monitor many different conditions.

• Refractory anemia: There are too few red blood cells in the blood and the patient has anemia. The number of white blood cells and platelets is normal.
• Refractory anemia with ringed sideroblasts: There are too few red blood cells in the blood and the patient has anemia. The red blood cells have too much iron. The number of white blood cells and platelets is normal.
• Refractory anemia with excess blasts: There are too few red blood cells in the blood and the patient has anemia. Five percent to 19% of the cells in the bone marrow are blasts and there are a normal number of blasts found in the blood. There also may be changes to the white blood cells and platelets. Refractory anemia with excess blasts may progress to acute myeloid leukemia. See the PDQ Adult Acute Myeloid Leukemia Treatment summary for more information.
• Refractory anemia with excess blasts in transformation: There are too few red blood cells, white blood cells, and platelets in the blood and the patient has anemia. Twenty percent to 30% of the cells in the bone marrow are blasts and more than 5% of the cells in the blood are blasts. Refractory anemia with excess blasts in transformation is sometimes called acute myeloid leukemia.
• Refractory cytopenia with multilineage dysplasia: There are too few of at least two types of blood cells. Less than 5% of the cells in the bone marrow are blasts and less than 1% of the cells in the blood are blasts. If red blood cells are affected, they may have extra iron. Refractory cytopenia may progress to acute leukemia.
• Myelodysplastic syndrome associated with an isolated del(5q) chromosome abnormality: There are too few red blood cells in the blood and the patient has anemia. Less than 5% of the cells in the bone marrow and blood are blasts. There is a specific change in the chromosome.
• Unclassifiable myelodysplastic syndrome: There are too few of one type of blood cell in the blood. The number of blasts in the bone marrow and blood is normal, and the disease is not one of the other myelodysplastic syndromes.

Treatment of essential thrombocythemia in patients younger than 60 years who have no symptoms and an acceptable platelet count is usually watchful waiting. Treatment of other patients may include the following:

• Chemotherapy
• Anagrelide therapy
• Biologic therapy using interferon alfa
• Platelet apheresis (therapeutic removal of platelets from the blood)
• A clinical trial of a new investigational treatment

Essential thrombocythemia often does not cause early symptoms. It is sometimes found during a routine blood test called the Complete Blood Count. The following symptoms may be caused by essential thrombocytopenia or by other conditions. A doctor should be consulted if any of these problems occur:

• Headache
• Burning or tingling in the hands or feet
• Redness and warmth of the hands or feet
• Vision or hearing problems

Platelets are sticky. When there are too many platelets, they may clump together and make it hard for the blood to flow. Clots may form in blood vessels and there may also be increased bleeding. These can cause serious health problems such as stroke or heart attack.

Essential thrombocythemia is a disease in which too many platelets (thrombocytes) in the blood.   This abnormal increase in the number of platelets in the blood is due to increased production by the bone marrow.

Treatment of primary myelofibrosis in patients without symptoms is usually watchful waiting. Treatment of primary myelofibrosis in patients with symptoms may include the following:

• Transfusion of red blood cells to relieve symptoms and improve quality of life
• Biologic therapy using interferon alfa or erythropoietic growth factors
• Splenectomy
• Radiation therapy to the spleen
• Chemotherapy
• Donor stem cell transplant
• Thalidomide or lenalidomide
• A clinical trial of a new treatment

Possible signs of primary myelofibrosis include pain below the ribs on the left side and feeling very tired.

• Feeling pain or fullness below the ribs on the left side
• Feeling full sooner than normal when eating
• Feeling very tired
• Shortness of breath
• Easy bruising or bleeding
• Petechiae (flat, red, pinpoint spots under the skin that are caused by bleeding)
• Fever
• Night sweats
• Weight loss
• A special blood test is used to diagnose primary myelofibrosis

The bone marrow is made of tissues that make blood cells (red blood cells, white blood cells, and platelets) and a web of fibers that support the blood-forming tissues. In primary myelofibrosis (also called chronic idiopathic myelofibrosis), large numbers of blood stem cells develop into blood cells that do not mature properly (blasts). The web of fibers inside the bone marrow also becomes very thick (like scar tissue) and slows the blood-forming tissue’s ability to make blood cells. This causes the blood-forming tissues to make fewer and fewer blood cells. In order to make up for the low number of blood cells made in the bone marrow, the liver and spleen begin to make the blood cells.

The purpose of treatment for polycythemia vera is to reduce the number of extra blood cells. Treatment of polycythemia vera may include the following:

• Phlebotomy (removing a therapeutic level of blood)
• Chemotherapy with or without phlebotomy
• Biologic therapy using interferon alfa
• Low- dose aspirin
• A clinical trial of a new treatment.
   

Possible signs of polycythemia vera include headaches and a feeling of fullness below the ribs on the left side.

• A feeling of pressure or fullness below the ribs on the left side
• Headaches
• Double vision or seeing dark or blind spots that come and go
• Itching all over the body, especially after being in warm or hot water
• Reddened face that looks like a blush or sunburn
• Weakness
• Dizziness
• Weight loss for no known reason

Special blood tests are used to diagnose polycythemia vera.  In addition to a complete blood count, bone marrow aspiration and biopsy, and cytogenetic analysis, a serum erythropoietin test is used to diagnose polycythemia vera.  In this test, a sample of blood is checked for the level of erythropoietin (a hormone that stimulates new red blood cells to be made).

Polycythemia vera is a disease in which too many red blood cells are made in the bone marrow.

Cancer Care Centers of South Texas offers Lipidpheresis and Plasmapheresis at  4411 Medical Drive, Suite 100 in San Antonio.  Please call 210-595-5300 for more information.

• Leukemia
• Multiple Myeloma
• Systemic Lupus erythematosus
• Chronic renal failure
• Relapsing Autoimmune Polymositis
• Polyneuropathy
• Myasthenia Gravis
• Sickle Cell crisis
• Hemophilia crisis
• Other

Our lipidpheresis program uses the Liposorber® System. Even though patients may follow a low-fat diet, take cholesterol-lowering medications, sometimes the LDL cholesterol level remains at a dangerous level. Treatment with the Liposorber® System quickly lowers the LDL-C level by 73-83% after one treatment. Our program treats patient candidates that have not responded to diet or maximum tolerated drug treatment for six months:

• Patient with LDL-C greater than or equal to 300 mg/dl
• Patients with LDL-C greater than or equal to 200 mg/dl and documented coronary heart disease

Our Liposorber® System treatment is safe and very well tolerated. Patients do not need replacement fluids and there are no significant changes in laboratory values (apart form lipid values) with long-term treatment. Since 1987, over 250,000 patients have been safely treated with the Liposorber® System worldwide.

Thank you for contacting Cancer Care Centers of South Texas.  We'll contact you soon.

CCCST Central Business Office:  40 NE Loop 410; Suite 500;  San Antonio, TX  78216

Call the Central Business Office at 210-424-1600 for general practice information only.  

Fax resumes and employment inquiries to the HR Coordinator at 210-212-5136 or 832-601-8108.

• For questions or inquiries related to your physician, appointments, prescriptions, PET scans, lab work, or to speak to your nurse, please call the specific physician office that you visit. To view all office locations and contact information for each, click here.
• For questions or inquiries related to your PET scan appointment or possible cancellation, please call 210-242-6506 BEFORE 4:00 PM on the day before your appointment.
• For life threatening medical emergencies, please call 911 or visit your nearest emergency room.

HIPAA
Please be aware that this is not a secure page.  Please do not send or request medical information regarding specific cases, and avoid using easily identifiable patient confidential information such as a name or patient ID number.

Effective Date: June 25, 2010
 
Cancer Care Centers of South Texas is committed to protecting your online privacy. We feel it is important for you to know how we handle the information we receive from you via the Cancer Care Centers of South Texas website. You can visit http://www.cancercaresouthtexas.com without revealing any personal information.
   
1. How We Collect And Use Personal Information
Cancer Care Centers of South Texas’ website may contain links to sites operated by third parties. Cancer Care Centers of South Texas has no control over the privacy policies and practices of such third party sites, and if you have any concerns, you are urged to review the terms of those sites for more information about the policies applicable to those sites.
 
2. IP Addresses
We collect and log the IP address of all visitors to cancercaresouthtexas.com. An IP address is a number automatically assigned to your computer whenever you access the Internet. IP addresses allow computers and servers to recognize and communicate with one another. We collect IP address information so that we can properly administer our system and gather aggregate information about how our site is being used, including the pages visitors are viewing. This aggregate information may be shared with advertisers, sponsors and other businesses. To maintain your anonymity, we do not associate IP addresses with records containing personal information. We will use IP address information, however, to personally identify you in order to enforce our legal rights or when required to do so by law enforcement authorities.
    
3. Newsletters
We require you to provide a valid e-mail address to participate in our email newsletter program. Your email will not be sold or shared with third parties.
 
4. How We Use Cookies
“Cookies” are small pieces of information that some web sites store on your computer's hard drive when you visit them. Like many other web sites, cancercaresouthtexas.com uses cookies to provide us with information relating to the sources of our site traffic. Collecting this information, however, does not allow us to personally identify you.
 
Most web browsers automatically accept cookies but allow you to modify security settings so that you can approve or reject cookies on a case-by-case basis. Our site requires that both cookies and JavaScript be enabled. If you reject cookies from our site, some parts of the site may not work properly for you.
 
5. Health Tools Information
You may need to provide personal information in order to use some of the health tools associated with our site. This information may include your answers to questions about your health status. This information is used to calculate risk. We don't store or share it.
 
6. Surveys
You may be asked to complete surveys when you visit cancercaresouthtexas.com. We use information from surveys to better understand the needs of our users and to gather information about health care trends and issues. We may share information from surveys with third parties who perform data management services for our site. Those third parties have agreed to keep all data from surveys confidential. Also, we may share information from surveys in an aggregated, de-identified form with third parties with whom we have a business relationship.
     
7. How We Protect Your Personal Information
Unless noted, personal data that you enter on this site are encrypted with secure server software (SSL). The encryption means that your data are protected while they are being transferred over the Internet to our servers.
Once your data reach our servers, the same state-of-the art security software that guards our company's essential business data protects your data as well.
 
In addition to using the most secure technology available, we de-identify all data before they are used in any aggregate reporting that may be done.
    
8. What We Provide To Third Parties
Except as noted above for surveys, Cancer Care Centers of South Texas does not provide any third party access to your IP address and e-mail address.

We may provide third parties with aggregate statistics about our visitors, traffic patterns and related site information. These data reflect site-usage patterns gathered during visits to our website each month, but they do not contain behavioral or identifying information about any individual member unless that member has given us permission to share that information.
   
9. Children's Privacy
This site is intended for adults age 18 and older. It is not intended for or designed to attract people under the age of 18. We do not collect personally identifiable information from any person we actually know to be under the age of 18.
 
10. E-mail Communications
E-mail communication that you send to us via the e-mail links on our site may be shared with a Cancer Care Centers of South Texas Customer Service representative, employee, medical expert or other agent who is most able to address your inquiry. We make every effort to respond in a timely fashion once communications are received. Once we have responded to your communication, it is discarded or archived, depending on the nature of the inquiry.
 
The e-mail functionality on our site does not provide a completely secure and confidential means of communication. It's possible that your e-mail communication may be accessed or viewed by another Internet user while in transit to us. If you wish to keep your communication private, do not use our e-mail.
 
11. Complaint Process
If you believe your privacy rights have been violated or if you have another complaint or problem, you may e-mail us by clicking the “Contact us” link at the bottom of any page. Our Customer Service department will forward your complaint to the appropriate  US Oncology department for response or resolution. You may also write to US Oncology Privacy Officer at:
   
Privacy Officer
US Oncology
10101 Woodloch Forest Dr.
The Woodlands, TX 77380

If you've contacted Cancer Care Centers of South Texas about a privacy-related concern and you do not believe your problem has been addressed, you may file a complaint by calling the US Oncology general number at (800) 381-2637 and asking for the Privacy Officer.
   
12. Changes To Our Privacy Policy
We will occasionally update this Privacy Policy. You will see the word “updated” followed by the date next to the Privacy Policy link near the bottom of all pages on the site. If the “updated” date has changed since you last visited, you're encouraged to review the policy to be informed of how this site is protecting your information.
 

 

World-Class Expertise

The physicians and staff of Cancer Care Centers of South Texas provide state-of-the-art treatment for cancer and disorders of the blood as well as clinical research trials. Our highly-qualified physician staff is comprised of 27 board-certified physicians in 17 locations in San Antonio, South Texas and the Hill Country.   

Our expertise includes medical oncology, hematology, radiation oncology, gynecologic oncology, and a skilled and compassionate team made up of RN's, nurse practitioners, and physician assistants specializing in the most advanced and personalized care of patients with cancer and blood disorders.

Cancer Care Centers of South Texas have been recognized nationally for expertise in the diagnosis, treatment and research of myelodysplasia and is designated as a "Center of Excellence" by the Myelodysplastic Syndromes Foundation.

 

San Antonio
4411 Medical Drive, Suite 100
210-595-5300 

New Braunfels
1448 E. Common St.
830-643-1762

Boerne
124 E. Bandera Rd., Suite 301
830-249-1429

Uvalde
1025 Garner Field Rd.
Uvalde, TX  78801
830-278-2469

E-mail for general information and questions
.(JavaScript must be enabled to view this email address)

HIPAA
Please be aware that this is not a secure page.  Please do not send or request information regarding specific cases, and avoid using easily identifiable patient confidential information such as a name or patient ID number.

Anticoagulation Clinics of North America (ACNA) is a network of anticoagulation clinics based on the principal that the maximum benefit of anticoagulation with the least risk is attainable through a dedicated anticoagulation management clinic.  ACNA was founded in 1994 to assist the physician in optimizing the efficacy and safety of antithrombotic therapy.  Through advancements in technology and clinical research, ACNA has formulated an unparalleled system for managing anticoagulation therapy for physicians and their patients.

With our approach to management, complications from bleeding and thrombosis were reduced by 50-80%.  Our ACNA program produced an average time in the INR range of 69.63% and 87.77% if the range is expanded by only +/-0.3 INR units.  This level of INR control is well above the 50-60% time in range seen with typical anticoagulation management.  The best results are obtained when patients are kept tightly in their designated range based on their risk for forming clots versus the risk of bleeding.

The ACNA Clinic

An anticoagulation clinic is an organized system to coordinate anticoagulation care for your patients.  Patients are seen face-to-face in an office setting where vital signs are taken, limited physical exams may be done, and concerns can be addressed. Rapid laboratory results allow us to give your patients written dosing instructions during the exam visit. Future visits are scheduled before patients leave the clinic to assure continued follow-up.

The ACNA Procedure

The most appropriate anticoagulation regimen and the optimal intensity and length of anticoagulation treatment is determined after thorough assessment of the patient’s risk of bleeding and thrombosis.  Each patient visit involves a highly-trained anticoagulation clinician.  Extensive and individualized patient education is given on the first visit and the education is reinforced at subsequent visits.  Our lab is strictly controlled for quality, and processes blood samples rapidly.  Unexpected results may be checked by an alternative method.  Dosage instructions are provided on a written dosage card and reviewed with the patient.  Standard procedure includes on-going communication with the patient’s physician, blood counts every 3 months, stool testing for bleeding is done yearly, and a yearly ACNA physician appointment.

• Out-patient and in-patient visits
• Hematologist available for hospital consults
• Rapid in-house PT/INR results
• Same-day dose management
• Management for dental work or surgery
• Quality Control
• Data management
• Timely reports back to referring physician

Indications for Referrals

• LV Thrombus
• MI
• CAD
• CAGB
• Low LVEF
• Diabetes
• Hypertension
• Pacemaker
• Age >65
• Previous stroke, TIA

Physicians and patients may be reluctant to use warfarin because of the fear of bleeding and/or unacceptability of close monitoring.  Aspirin is perceived to be less dangerous than warfarin.  However, when monitored appropriately, the risk of bleeding with warfarin is not significantly different than the risk of bleeding with aspirin or placebo.

Should warfarin (Coumadin) be considered for a patient with atrial filbrillation who has been maintained successfully with aspirin for 10 years?

Current guidelines (*CHEST, 2004) advocate the use of warfarin preferentially for stroke prophylaxis in atrial fibrillation.  Should all patients be converted to warfarin?  Studies that have shown efficacy target the INR range between 2.0 and 3.0.  An INR of 1.7 provides one-half the protection of an INR of 2.0.  At an INR of 1.5, most of the efficacy of warfarin in atrial fibrillation is lost.  When study data were analyzed for only those patients who were actually taking warfarin, an 85% reduction in stroke was observed.

*Singer DE, Albers GW, Dalen JE, et al., Antithrombotic therapy in atrial filbrillation, CHEST, 2004, 126 (3)(suppl):4295-4565.  For full list of other references, and more information, please contact us at .(JavaScript must be enabled to view this email address), or call the clinic at 210-595-5300.

ACNA Contact Information and Locations

For hospital consultations OR patient referrals, please call 210-595-5300.

ACNA Clinicians

Roger M. Lyons, MD, FACP, Medical Director of ACNA

Henry I. Bussey, PharmD., FCCP, Clinical Director of ACNA

Catarina Do, PA-C

Robert Scott Kronenthal, MSN, RN, CS-FNP

Michael W. Vermeulen, MPAS, PA-C

Suzanne McGregor, MSN, RN, FNP/GNP-BCrs

Erica Carone, RPA-C

Links to other relevant websites

Anticoagulation FORUM
acforum.org

The Thrombosis Interest Group of Canada
tigc.org

ClotCare Online Resource
Clotcare.com

American Venous Forum
venous-info.com

What is an anticoagulation clinic?

Over 6 million people worldwide take oral anticoagulation medications such as warfarin to reduce the body's chances of forming dangerous blood clots.   Our anticoagulation clinic is a special clinic dedicated to managing patients' dosage of blood thinning medications, such as warfarin.  Patients are maintained in the optimal therapeutic range to prevent complications such as unwanted blood clotting, or excessive bleeding. Our anticoagualation specialists see patients on a regular basis for physical exams, laboratory testing, and to provide dosing instructions for patients, as well as timely reporting back to the their own physicians regarding management of their anticoagulation therapy.

What happens on the first visit to the ACNA clinic?

On your first visit, or if you are in the hospital, you will be seen first by our Hematologist (physician who specializes in blood disorders) who will evaluate your case and do a physical exam and order laboratory testing.  Your follow-up visits will be provided by our specialized ACNA clinicians in the ACNA clinic and may include exams, lab tests, education, and medication dosing instructions.

What is a typical visit to the ACNA clinic like?

A typical follow-up visit will take about 15-30 minutes.   You will have blood drawn in our laboratory and then you will see one of our clinicians in an exam room.  You will be able to tell the clinician about any recent changes in your health, complaints, or symptoms that you might have.  With this information and your lab test results, the clinician will review your chart information and determine if your anticoagulation medication (such as warfarin, or Coumadin) dose will stay the same, or be adjusted.  If your dose needs to be adjusted, the clinician will give you a dose card with instructions on how much medication to take.

What types of patients do you take care of?

We see patients with a variety of disorders such as, abnormal heart rhythm, heart valve replacement, heart attack, deep vein thrombosis (clots in the thigh, leg, or pelvis), stroke, pulmonary embolism (clots that travel to the lungs), and a variety of other disorders.

Why is anticoagulation therapy management necessary?

The effectiveness of oral anticoagulation therapy, such as warfarin, can change over time due to changes in the patients diet, other medications or illnesses the patient may experience, or alcohol usage and lifestyle changes.  Because of these changes, patients on oral anticoagulation medications require close monitoring of their blood clotting time, through laboratory tests, such as PT/INR, to maintain the patient in the desired therapeutic range to avoid unwanted blood clots, or excessive bleeding.

What is PT?

PT is the abbreviation for Prothrombin Time.  This lab test is the most common method to determine the clotting time of a patient’s blood.  Results are reports as the number of seconds it takes for the blood to clot during the laboratory test.

What is an INR?

INR stands for International Normalized Ratio, which is the accepted as the standard unit for reporting the Prothrombin Time results.  The INR is a conversion unit that takes into account differences between various testing regimens to normalize the results.

Will my regular doctor know how I am doing?

Yes!  Our ACNA clinicians communicate with your primary care doctor and all other referring physicians.  They provide updates on a regular basis to your doctors, as well as find out about any additional problems that might require immediate attention.

How are patients referred to an ACNA clinic?

Referrals can be made by your physician.  You may ask your physician for a referral for management of your anticoagulation medication.  You will remain under the care of your physician and we will manage your oral anticoagulation medications to keep your dose in the correct range to avoid problems with clotting or excessive bleeding.  This helps your physician, and helps reduce emergency room visits, hospital stays, and the overall cost of your medical care.  We typically receive referrals from these types of physicians:  cardiologists, neurologists, vascular surgeons, internal medicine, and family practice physicians.  Your physician may call 210-595-5300 to refer you to one of our clinics.

Are your clinicians available for questions or problems?

Yes!  There are several ways to contact us.  You may e-mail us at .(JavaScript must be enabled to view this email address) for general information or call our main phone number, 210-595-5300, for information about getting a referral.  As always, for medical emergencies please call 911 for immediate help.  Referring physicians may call 210-595-5300 for emergency consultations. 

Where Can I Find More Information?

ClotCare Online Resource

Coumadin

Thrombophilia Support Page

HIPAA

Please be aware that this is not a secure page.  Please do not send or request information regarding specific cases, and avoid using easily identifiable patient confidential information such as a name or patient ID number

The most appropriate anticoagulation dosing therapy is determined after our clinicians determine the patients risk of excessive bleeding versus developing blood clots.  Each patient receives a physical exam, review of their medical history, and extensive education about their anticoagulation therapy and medications at their first visit.  Follow-up visits are necessary to monitor patients to ensure optimum dosing throughout the time they are receiving anticoagulation medications, such as warfarin (Coumadin®).

Anticoagulation therapy can be managed for patients that might require dental work or surgery while receiving blood-thinning medications such as warfarin.  Patients can be seen in our clinic, or our hematologist is available for consultations with physicians for hospitalized patients receiving warfarin. 

• Individualized care for each patient
• Comprehensive education
• Written dosing informaiton card given to each patient
• Same-day management
• Ongoing communication with patient's own physician
• Coordinated follow-up care

The laboratory is strictly controlled for quality and accuracy. Our lab processes blood samples in less than 10 minutes.  Once our clinicians receive the patient’s lab results, written dosing instructions are provided on a written dosing card, and are reviewed with and provided to the patient.

Links to other relevant sites

Coumadin.com

ClotCare Online Resource

American Venous Forum

Thrombophilia Support Page

Lovenox.com

Radiation therapy is the use of high-energy x-rays or radioactive materials to kill cancer cells. This radiation injures the cancer cells so that they can no longer continue to divide and multiply.  Each treatment causes more cells to die, reducing the size of the cancerous tumor. Radiation therapy incorporates various techniques, including external electron or photon beams or internal radiation.  The treatment is odorless and invisible.  Your radiation oncologist and medical oncologist will work together closely to determine if your treatment will include radiation therapy. 

Our radiation oncology team uses the most advanced treatment planning systems and state-of-the-art technology to deliver internal and external radiation to cancerous cells, with the intent of eradicating the existing disease and preventing further growth. Whether your treatment plan includes Intensity Modulated Radiation Therapy (IMRT) or 3-D Radiation Therapy, you can receive your radiation therapy right here in our offices on an outpatient basis.  Intensity Modulated Radiation Therapy (IMRT) is an advanced form of radiation therapy allowing the radiation oncologist to precisely target tumors by using Computed Tomography (CT) to build three-dimensional images to accurately target treatment using tightly focused radiation beams of varying intensity. IMRT allows the radiation oncologist to maximize tumor dosage while minimizing radiation exposure to nearby uninvolved tissues and thereby reducing the occurrence of treatment related side effects.

    

Cancer Care Centers of South Texas offers cutting-edge radiation therapy technologies including radiation therapy clinical research trials.

• Intensity-Modulated Radiation Therapy (IMRT)
• CT-based 3D conformal radiation treatment planning
• Brachytherapy
• Gamma Knife Radiosurgery
• Cyber Knife Radiosurgery
• Radioimmunotherapy
• Radiopharmaceutical therapy
   

Chemotherapy is used to treat many types of cancer.  Chemotherapy drugs are also called anticancer drugs because they work to destroy cancer cells.  Sometimes two or more drugs are used together, which is called combination chemotherapy. In addition, an oncologist may prescribe other types of drugs such as hormones, biological therapies, or supportive care. Treatment side effects may not occur, or can vary depending on the treatment regimen received. Throughout treatment, patients are monitored very closely by the healthcare team and counseled about nutrition, exercise, and side-effect prevention and treatment.

Our physicians and nursing staff will guide you through your cancer treatment experience, helping you every step of the way.  Cancer Care Centers of South Texas provides out-patient chemotherapy which does not involved a hospital stay and allows patients to return to their homes following their treatment appointments.

Many of our physicians are available to speak to small and large groups of medical professionals and/or community members.

• Roger M. Lyons, MD, FACP
• Sridhar Beeram, MD
• J. Brant Ellis, MD
• Suneetha Challagundla, MD
• Ather Siddiqi, MD
• Sharon Wilks, MD
• Allyson Harroff, MD
• Gregory Guzley, MD

• Update on Breast Cancer
• Update on Colon Cancer
• Update on Lung Cancer
• Update on Prostate Cancer
• Update on Leukemia and Lymphoma
• Update on MDS Research and Treatment Options
• Update on DVT Research and Treatment Options
• Update on ITP Research and Treatment Options
• Cancer Awareness, Screening and Early Detection
• Clinical Trials and Research
• Cancer Survivorship
• Dr. Guzley is available for "Alternative Cancer Treatments"

Thank you for referring your patient to Cancer Care Centers of South Texas. Please complete the fax referral form for the location that your patient will be visiting.

After a referral is made, our New Patient Coordinator will call the patient to complete the pre-registration process. The patient may be asked to bring pathology slides (if they have not been sent previously), films, scans or other materials pertaining to his or her case. After the patient has been seen and the evaluation is complete, the referring physician will be sent a written report of the findings and recommendations. Cancer Care Centers of South Texas encourages and supports the referring physician's continued participation in every stage of the patient's care..

Click the name of the location to view the address, physicians and services available.  Below the location information is the link to the fax referral forms for each site.

Medical Center Cancer Center
Location Information
Medical Center Referral Form

Metropolitan (Downtown) Cancer Center
Location Information
Metropolitan Referral Form

Northeast Cancer Center
Location Information
Northeast Referral Form

New Braunfels
Location Information
New Braunfels Referral Form

Stone Oak
Location Information
Stone Oak Referral Form

Southeast
Location Information
Southeast Referral Form

Boerne
Location Information
Boerne Referral Form

Fredericksburg
Location Information
Fredericksburg Referral Form

Jourdanton
Location Information
Jourdanton Referral Form

Kerrville
Location Information
Kerrville Referral Form

Marble Falls
Location Information
Marble Falls Referral Form

Seguin
Location Information
Seguin Referral Form

Uvalde
Location Information
Uvalde Referral Form

Hondo
Location Information
Hondo Referral Form

Westover Hills
Location Information
Westover Hills Referral Form

Schertz
Location Information
Schertz Referral Form

UNITED WE FIGHT

Cancer is no match for the united strength of US Oncology.

Cancer Care Centers of South Texas is UNITED IN HEALING with US Oncology.

US Oncology is the nation’s premier oncology services company, increasing patient access to safe, high-quality cancer care.  Working closely with physicians, manufacturers, and payers, we develop innovative new approaches to confronting cancer, increasing the effectiveness of care, and ensuring a better patient experience. US Oncology is the nation’s premier oncology services company, increasing patient access to safe, high-quality cancer care.  Working closely with physicians, manufacturers, and payers, we develop innovative new approaches to confronting cancer, increasing the effectiveness of care, and ensuring a better patient experience.

The Cancer Care Centers of South Texas Central Business Office is located at 40 NE Loop 410, Suite 500, San Antonio, TX  78216. To reach the business office you may call 210-424-1600.

To reach your physician, speak to your nurse, make an appointment or ask questions related to your treatment program please contact your physician's office directly.

For life-threatening medical emergencies, please call 911 or go to your nearest emergency room.

Our Locations.

Our Physicians.

Cancer Care Centers of South Texas operates 17 sites of service in San Antonio and the surrounding area and has 27 board-certified physicians specializing in all types of cancer and hematological disorders.  Our physician experts are available for interviews or speaking engagements and can provide information about cancer, cancer treatments, specific cancer and hematological diseases, and also the latest advances in cancer research and clinical trials.  Please see our special Speakers Bureau section for more information.

For media inquiries, our marketing department can be reached by phone, fax, or e-mail:

Manager of Marketing Services

Phone: 210-242-6531

Fax: 210-212-5136

Send e-mail

The BEST Today For Your LIFE Tomorrow

Our goal is to offer the best, most effective, compassionate and personalized care available to patients with cancer and blood disorders while helping patients maintain their quality of life, all close to home.

At Cancer Care Centers of South Texas our team of board-certified specialists provide the most advanced and personalized care to patients in the San Antonio area including, New Braunfels, Seguin, Kerrville, Fredericksburg, Marble Falls, Boerne, Uvalde, Jourdanton and Schertz.  Our team includes board-certified Medical Oncology, Hematology, Gynecologic Oncology and Radiation Oncology physician specialists working together with certified physician assistants, oncology certified nurses, and certified radiation, imaging, laboratory, pharmacy, dietary and research professionals to provide patients with the best and most advanced care available.  The medical oncologist or gynecologic oncologist serves as the main caregiver for a patient with cancer from the point of diagnosis and throughout the entire course of treatment, coordinating the care provided by the Radiation Oncologist, other specialists and an entire team of professionals.

To ensure the highest quality of patient care, all of the chemotherapy and therapeutic drugs we provide are supplied to us through the US Oncology safe and secure drug distribution program.  In fact, Cancer Care Centers of South Texas is the only physician practice in the San Antonio area that provides this level of distribution safety for chemotherapy and therapeutic drugs.

Cancer Care Centers of South Texas have been recognized nationally for expertise in the diagnosis, treatment and research of myelodysplasia and is designated as a "Center of Excellence" by the The Myelodysplastic Syndromes Foundation.

To ensure that cancer patients continue to have access to the latest advancements, Cancer Care Centers of South Texas maintains a strong voice in patient advocacy. Our national network not only allows us to play a unique role, it compels us to do so. Cancer Care Centers of South Texas is obligated to help patients access the information they need to make rational decisions about care and care-related public policy initiatives. Therefore, we serve as a resource for patient advocacy groups, help those on the frontlines of patient care reform, and communicate with patients on issues relating to treatment choices and rights.

The following resources offer important information and action alerts on public policies and legislative issues affecting cancer care.

US Oncology LegisLink
A Community Education Service of US Oncology. Among the many resources included here are tips on meeting with your Senators and Representatives; a Public Relations toolkit and access to Sign-On Letters for cancer care.

National Patient Advocacy Foundation
A national non-profit organization providing the patient voice in improving access to, and reimbursement for, high-quality healthcare through regulatory and legislative reform at the state and federal levels. NPAF translates the experience of millions of patients who have been helped through professional case management services to individuals facing barriers to healthcare access for chronic and disabling disease, medical debt crisis and employment-related issues at no cost.

 

As part of our patient care services, we provide financial counseling for our patients.  Once your CCCST physician has established your treatment plan we will arrange for you to meet with one of our financial counselors to discuss your medical insurance, co-pays, out-of-pocket expenses and our billing policies.  Patients are responsible for the co-pay and out-of-pocket expenses related to their office visits, lab tests, procedures and treatments.

There are several programs for eligible patients that are having difficulties in paying their out-of-pocket expenses and co-pays, that are based on need and on an individual basis:

• Patient Assistance Programs- Many pharmaceutical companies provide eligible patients with medication assistance.
• Co-pay Assistance Programs- These programs provide financial assistance for out-of-pocket treatment expenses related to a specific diagnosis.

Factors That are Known to Increase the Risk of Cancer

Cigarette Smoking and Tobacco Use

Tobacco use is strongly linked to an increased risk for many kinds of cancer. Smoking cigarettes is the leading cause of the following types of cancer:

• Acute myelogenous leukemia (AML)
• Bladder cancer
• Cervical cancer
• Esophageal cancer
• Kidney cancer
• Lung cancer
• Oral cavity cancer
• Pancreatic cancer
• Stomach cancer

Not smoking or quitting smoking lowers the risk of getting cancer and dying from cancer. Scientists believe that cigarette smoking causes about 30% of all cancer deaths in the United States.

See the following National Cancer Institute PDQ summaries for more information:

• Lung Cancer Prevention
• Prevention and Cessation of Cigarette Smoking: Control of Tobacco Use

Infections

Certain viruses and bacteria may possibly able to cause cancer. Viruses and other infection-causing agents cause more cases of cancer in the developing world (about 1 in 4 cases of cancer) than in developed nations (less than 1 in 10 cases of cancer). Examples of cancer-causing viruses and bacteria include:

• Human papillomavirus (HPV) increases the risk for cancers of the cervix, penis, vagina, anus, and oropharynx.
• Hepatitis B and hepatitis C viruses increase the risk for liver cancer.
• Epstein-Barr virus increases the risk for Burkitt lymphoma.
• Helicobacter pylori increases the risk for gastric cancer.

Two vaccines prevent infection by cancer-causing agents have already been developed and approved by the U.S. Food and Drug Administration (FDA). One is a vaccine to prevent infection with hepatitis B virus. The other protects against infection with strains of human papillomavirus (HPV) that cause cervical cancer. Scientists continue to work on vaccines against infections that cause cancer.

See the following National Cancer Institute PDQ summaries for more information:

• Cervical Cancer Prevention
• Liver (Hepatocellular) Cancer Prevention
• Stomach (Gastric) Cancer Prevention
• Oral Cancer Prevention

Radiation

Being exposed to radiation is a known cause of cancer. There are two main types of radiation linked with an increased risk for cancer:

• Ultraviolet radiation from sunlight: This is the main cause of nonmelanoma skin cancers.
• Ionizing radiation from medical x-rays and radon gas in our homes: Scientists believe that ionizing radiation causes leukemia, thyroid cancer, and breast cancer in women. Ionizing radiation may also be linked to myeloma and cancers of the lung, stomach, colon, esophagus, bladder, and ovary. Being exposed to radiation from diagnostic x-rays increases the risk of cancer in patients and x-ray technicians. 

See the following National Cancer Institute PDQ summaries for more information:

• Breast Cancer Prevention
• Skin Cancer Prevention 

Factors That May Affect the Risk of Cancer

Diet

The foods that you eat on a regular basis make up your diet. Diet is being studied as a risk factor for cancer. It is hard to study the effects of diet on cancer because a person’s diet includes foods that may protect against cancer and foods that may increase the risk of cancer.

It is also hard for people who take part in the studies to keep track of what they eat over a long period of time. This may explain why studies have different results about how diet affects the risk of cancer.

Some studies show that fruits and nonstarchy vegetables may protect against cancers of the mouth, esophagus, and stomach. Fruits may also protect against lung cancer.

Some studies have shown that a diet high in fat, proteins, calories, and red meat increases the risk of colorectal cancer, but other studies have not shown this.

It is not known if a diet low in fat and high in fiber, fruits, and vegetables lowers the risk of colorectal cancer.  See the American Institute for Cancer Research for more information about foods that prevent cancer.

See the following PDQ summaries for more information:

• Breast Cancer Prevention
• Colorectal Cancer Prevention

 Alcohol

Studies have shown that drinking alcohol is linked to an increased risk of the following types of cancers:

• Oral cancer.
• Esophageal cancer.
• Breast cancer.
• Colorectal cancer (in men).

Drinking alcohol may also increase the risk of liver cancer and female colorectal cancer.

See the following National Cancer Institute PDQ summaries for more information:

• Breast Cancer Prevention
• Colorectal Cancer Prevention
• Esophageal Cancer Prevention
• Oral Cancer Prevention
• Liver (Hepatocellular) Cancer Prevention

Physical Activity

Studies show that people who are physically active have a lower risk of certain cancers than those who are not. It is not known if physical activity itself is the reason for this.

Studies show a strong link between physical activity and a lower risk of colorectal cancer. Some studies show that physical activity protects against postmenopausal breast cancer and endometrial cancer.

See the following National Cancer Institute PDQ summaries for more information:

• Breast Cancer Prevention
• Colorectal Cancer Prevention
• Endometrial Cancer Prevention

Obesity

Studies show that obesity is linked to a higher risk of the following types of cancer:

• Postmenopausal breast cancer.
• Colorectal cancer.
• Endometrial cancer.
• Esophageal cancer.
• Kidney cancer.
• Pancreatic cancer.

Some studies show that obesity is also a risk factor for cancer of the gallbladder.

Studies do not show that losing weight lowers the risk of cancers that have been linked to obesity.

See the following National Cancer Institute PDQ summaries for more information:

• Breast Cancer Prevention
• Colorectal Cancer Prevention
• Endometrial Cancer Prevention
• Lung Cancer Prevention

Information provided the National Cancer Institute.

De Novo and Secondary Myelodysplastic Syndromes

Treatment of de novo and secondary myelodysplastic syndromes may include the following:

• Supportive care with transfusion therapy.
• High-dose chemotherapy with stem cell transplant using stem cells from a donor.
• Supportive care with growth factor therapy.
• Chemotherapy with azacitidine, decitabine, or other anticancer drugs.
• Supportive care with drug therapy.
• A clinical trial of a new anticancer drug.
• A clinical trial of low- dose chemotherapy with stem cell transplant using stem cells from a donor.
• A clinical trial of a combination of treatments.
• A clinical trial of growth factor therapy.

Previously Treated Myelodysplastic Syndromes

Treatment of previously treated myelodysplastic syndromes may include the following:

• High-dose chemotherapy with stem cell transplant using stem cells from a donor.
• Chemotherapy with azacitidine or decitabine.
• Supportive care with transfusion therapy, growth factor therapy, and/or drug therapy.
• A clinical trial of low- dose chemotherapy with stem cell transplant using stem cells from a donor.
• A clinical trial of new drug therapy.
• A clinical trial of a combination of treatments.
• A clinical trial of growth factor therapy.

There are several types of myelodysplastic syndromes.

Myelodysplastic syndromes have too few of one or more types of healthy blood cells in the bone marrow or blood. Myelodysplastic syndromes include the following diseases:

• Refractory anemia
• Refractory anemia with ringed sideroblasts.
• Refractory anemia with excess blasts.
• Refractory anemia with excess blasts in transformation.
• Refractory cytopenia with multilineage dysplasia.
• Myelodysplastic syndrome associated with an isolated del(5q) chromosome abnormality.
• Unclassifiable myelodysplastic syndrome.

There is no staging system for myelodysplastic syndromes. Treatment is based on whether the disease developed after the patient was exposed to factors that cause myelodysplastic syndrome or whether the disease was previously treated. Myelodysplastic syndromes are grouped for treatment as follows:

• De novo myelodysplastic syndromes develop without any known cause.

• Secondary myelodysplastic syndromes develop after the patient was treated with chemotherapy or radiation therapy for other diseases or after being exposed to radiation or certain chemicals that are linked to the development of myelodysplastic syndromes. Secondary myelodysplastic syndromes may be harder to treat than de novo myelodysplastic syndromes.

• Previously treated myelodysplastic syndromes

• The myelodysplastic syndrome has been treated but has not gotten better.

Myelodysplastic syndromes are a group of diseases in which the bone marrow does not make enough healthy blood cells.

Myelodysplastic syndromes are diseases of the blood and bone marrow. Normally, the bone marrow makes blood stem cells (immature cells) that develop into mature blood cells over time. A blood stem cell may become a myeloid stem cell or a lymphoid stem cell. The lymphoid stem cell develops into a white blood cell. The myeloid stem cell develops into one of three types of mature blood cells:

• Red blood cells that carry oxygen and other materials to all tissues of the body.
• White blood cells that fight infection and disease.
• Platelets that help prevent bleeding by causing blood clots to form.

Cancer Care Centers of South Texas have been recognized nationally for expertise in the diagnosis, treatment and research of myelodysplasia and is designated as a "Center of Excellence" by the The Myelodysplastic Syndromes Foundation.

Lo que usted necesita saber sobre síndromes mielodisplásicos.

People with multiple myeloma have many treatment options. The options are watchful waiting, induction therapy, and stem cell transplant. Sometimes a combination of methods is used.

Radiation therapy is used sometimes to treat painful bone disease. It may be used alone or along with other therapies. See the Supportive Care section to learn about ways to relieve pain.

The choice of treatment depends mainly on how advanced the disease is and whether you have symptoms. If you have multiple myeloma without symptoms (smoldering myeloma), you may not need cancer treatment right away. The doctor monitors your health closely (watchful waiting) so that treatment can start when you begin to have symptoms.

If you have symptoms, you will likely get induction therapy. Sometimes a stem cell transplant is part of the treatment plan.

When treatment for myeloma is needed, it can often control the disease and its symptoms. People may receive therapy to help keep the cancer in remission, but myeloma can seldom be cured. Because standard treatment may not control myeloma, you may want to talk to your doctor about taking part in a clinical trial. Clinical trials are research studies of new treatment methods.

Watchful Waiting

People with smoldering myeloma or Stage I myeloma may be able to put off having cancer treatment. By delaying treatment, you can avoid the side effects of treatment until you have symptoms.

If you and your doctor agree that watchful waiting is a good idea, you will have regular checkups (such as every 3 months). You will receive treatment if symptoms occur.

Although watchful waiting avoids or delays the side effects of cancer treatment, this choice has risks. In some cases, it may reduce the chance to control myeloma before it gets worse.

You may decide against watchful waiting if you don’t want to live with untreated myeloma. If you choose watchful waiting but grow concerned later, you should discuss your feelings with your doctor. Another approach is an option in most cases.

Induction Therapy

Many different types of drugs are used to treat myeloma. People often receive a combination of drugs, and many different combinations are used to treat myeloma.

Each type of drug kills cancer cells in a different way:

• Chemotherapy: Chemotherapy kills fast-growing myeloma cells, but the drug can also harm normal cells that divide rapidly.

• Targeted therapy: Targeted therapies use drugs that block the growth of myeloma cells. The targeted therapy blocks the action of an abnormal protein that stimulates the growth of myeloma cells.

• Steroids: Some steroids have antitumor effects. It is thought that steroids can trigger the death of myeloma cells. A steroid may be used alone or with other drugs to treat myeloma.

You may receive the drugs by mouth or through a vein (IV). The treatment usually takes place in an outpatient part of the hospital, at your doctor’s office, or at home. Some people may need to stay in the hospital for treatment.

Stem Cell Transplant

Many people with multiple myeloma may get a stem cell transplant. A stem cell transplant allows you to be treated with high doses of drugs. The high doses destroy both myeloma cells and normal blood cells in the bone marrow. After you receive high-dose treatment, you receive healthy stem cells through a vein. (It’s like getting a blood transfusion.) New blood cells develop from the transplanted stem cells. The new blood cells replace the ones that were destroyed by treatment.

Stem cell transplants take place in the hospital. Some people with myeloma have two or more transplants.

Stem cells may come from you or from someone who donates their stem cells to you:

• From you: An autologous stem cell transplant uses your own stem cells. Before you get the high-dose chemotherapy, your stem cells are removed. The cells may be treated to kill any myeloma cells present. Your stem cells are frozen and stored. After you receive high-dose chemotherapy, the stored stem cells are thawed and returned to you.

• From a family member or other donor: An allogeneic stem cell transplant uses healthy stem cells from a donor. Your brother, sister, or parent may be the donor. Sometimes the stem cells come from a donor who isn’t related. Doctors use blood tests to be sure the donor’s cells match your cells. Allogeneic stem cell transplants are under study for the treatment of multiple myeloma.

• From your identical twin: If you have an identical twin, a syngeneic stem cell transplant uses stem cells from your healthy twin.

There are two ways to get stem cells for people with myeloma. They usually come from the blood (peripheral blood stem cell transplant). Or they can come from the bone marrow (bone marrow transplant).

After a stem cell transplant, you may stay in the hospital for several weeks or months. You’ll be at risk for infections because of the large doses of chemotherapy you received. In time, the transplanted stem cells will begin to produce healthy blood cells.

If the biopsy shows that you have multiple myeloma, your doctor needs to learn the extent (stage) of the disease to plan the best treatment. Staging may involve having more tests:

• Blood tests: For staging, the doctor considers the results of blood tests, including albumin and beta-2-microglobulin.

• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your bones.

• MRI: A powerful magnet linked to a computer is used to make detailed pictures of your bones.

Doctors may describe multiple myeloma as

• Smoldering
• Stage I
• Stage II
• Stage III

The stage takes into account whether the cancer is causing problems with your bones or kidneys. Smoldering multiple myeloma is early disease without any symptoms. For example, there is no bone damage. Early disease with symptoms (such as bone damage) is Stage I. Stage II or III is more advanced, and more myeloma cells are found in the body.

Doctors sometimes find multiple myeloma after a routine blood test. More often, doctors suspect multiple myeloma after an x-ray for a broken bone. Usually though, patients go to the doctor because they are having other symptoms.

To find out whether such problems are from multiple myeloma or some other condition, your doctor may ask about your personal and family medical history and do a physical exam. Your doctor also may order some of the following tests:

• Blood tests: The lab does several blood tests:
  • Multiple myeloma causes high levels of proteins in the blood. The lab checks the levels of many different proteins, including M protein and other immunoglobulins (antibodies), albumin, and beta-2-microglobulin.
  • Myeloma may also cause anemia and low levels of white blood cells and platelets. The lab does a complete blood count to check the number of white blood cells, red blood cells, and platelets.
  • The lab also checks for high levels of calcium.
  • To see how well the kidneys are working, the lab tests for creatinine.

• Urine tests: The lab checks for Bence Jones protein, a type of M protein, in urine. The lab measures the amount of Bence Jones protein in urine collected over a 24-hour period. If the lab finds a high level of Bence Jones protein in your urine sample, doctors will monitor your kidneys. Bence Jones protein can clog the kidneys and damage them.

• X-rays: You may have x-rays to check for broken or thinning bones.An x-ray of your whole body can be done to see how many bones could be damaged by the myeloma.

• Biopsy: Your doctor removes tissue to look for cancer cells. A biopsy is the only sure way to know whether myeloma cells are in your bone marrow. Before the sample is taken, local anesthesia is used to numb the area. This helps reduce the pain. Your doctor removes some bone marrow from your hip bone or another large bone. A pathologist uses a microscope to check the tissue for myeloma cells.

There are two ways your doctor can obtain bone marrow. Some people will have both procedures during the same visit:

• Bone marrow aspiration: The doctor uses a thick, hollow needle to remove samples of bone marrow.

• Bone marrow biopsy: The doctor uses a very thick, hollow needle to remove a small piece of bone and bone marrow.

Myeloma begins when a plasma cell becomes abnormal. The abnormal cell divides to make copies of itself. The new cells divide again and again, making more and more abnormal cells. These abnormal plasma cells are called myeloma cells.

In time, myeloma cells collect in the bone marrow. They may damage the solid part of the bone. When myeloma cells collect in several of your bones, the disease is called “multiple myeloma.” This disease may also harm other tissues and organs, such as the kidneys.

Myeloma cells make antibodies called M proteins and other proteins. These proteins can collect in the blood, urine, and organs.

Visit the National Cancer Institute where this information and more can be found about Multiple Myeloma or ask your cancer care team questions about your individual situation.

Your doctor can describe your treatment choices and the expected results. You and your doctor can work together to develop a treatment plan that meets your needs.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat Hodgkin lymphoma include hematologists, medical oncologists, and radiation oncologists . Your doctor may suggest that you choose an oncologist who specializes in the treatment of Hodgkin lymphoma. Often, such doctors are associated with major academic centers. Your health care team may also include an oncology nurse and a registered dietitian.

The choice of treatment depends mainly on the following:

• The type of your Hodgkin lymphoma (most people have classical Hodgkin lymphoma)

• Its stage (where the lymphoma is found)

• Whether you have a tumor that is more than 4 inches (10 centimeters) wide

• Your age

• Whether you’ve had weight loss, drenching night sweats, or fevers.

People with Hodgkin lymphoma may be treated with chemotherapy, radiation therapy, or both.

If Hodgkin lymphoma comes back after treatment, doctors call this a relapse or recurrence. People with Hodgkin lymphoma that comes back after treatment may receive high doses of chemotherapy, radiation therapy, or both, followed by stem cell transplantation.

Chemotherapy

Chemotherapy for Hodgkin lymphoma uses drugs to kill lymphoma cells. It is called systemic therapy because the drugs travel through the bloodstream. The drugs can reach lymphoma cells in almost all parts of the body.

Usually, more than one drug is given. Most drugs for Hodgkin lymphoma are given through a vein (intravenous), but some are taken by mouth.

Chemotherapy is given in cycles. You have a treatment period followed by a rest period. The length of the rest period and the number of treatment cycles depend on the stage of your disease and on the anticancer drugs used.

You may have your treatment in a clinic, at the doctor’s office, or at home. Some people may need to stay in the hospital for treatment.

Radiation Therapy

Radiation therapy (also called radiotherapy) for Hodgkin lymphoma uses high-energy rays to kill lymphoma cells. It can shrink tumors and help control pain.

A large machine aims the rays at the lymph node areas affected by lymphoma. This is local therapy because it affects cells in the treated area only. Most people go to a hospital or clinic for treatment 5 days a week for several weeks.

Stem Cell Transplantation

If Hodgkin lymphoma returns after treatment, you may receive stem cell transplantation. A transplant of your own blood-forming stem cells (autologous stem cell transplantation) allows you to receive high doses of chemotherapy, radiation therapy, or both. The high doses destroy both Hodgkin lymphoma cells and healthy blood cells in the bone marrow.

Stem cell transplants take place in the hospital. Before you receive high-dose treatment, your stem cells are removed and may be treated to kill lymphoma cells that may be present. Your stem cells are frozen and stored. After you receive high-dose treatment to kill Hodgkin lymphoma cells, your stored stem cells are thawed and given back to you through a flexible tube placed in a large vein in your neck or chest area. New blood cells develop from the transplanted stem cells.

The doctor considers the following to determine the stage of Hodgkin lymphoma:

• The number of lymph nodes that have Hodgkin lymphoma cells

• Whether these lymph nodes are on one or both sides of the diaphragm (see picture)

• Whether the disease has spread to the bone marrow, spleen, liver, or lung.

The stages of Hodgkin lymphoma are as follows:

• Stage I: The lymphoma cells are in one lymph node group (such as in the neck or underarm). Or, if the lymphoma cells are not in the lymph nodes, they are in only one part of a tissue or an organ

• Stage II: The lymphoma cells are in at least two lymph node groups on the same side of (either above or below) the diaphragm. Or, the lymphoma cells are in one part of a tissue or an organ and the lymph nodes near that organ (on the same side of the diaphragm). There may be lymphoma cells in other lymph node groups on the same side of the diaphragm.

• Stage III: The lymphoma cells are in lymph nodes above and below the diaphragm. Lymphoma also may be found in one part of a tissue or an organ (such as the liver, lung, or bone) near these lymph node groups. It may also be found in the spleen.

• Stage IV: Lymphoma cells are found in several parts of one or more organs or tissues. Or, the lymphoma is in an organ (such as the liver, lung, or bone) and in distant lymph nodes.

• Recurrent: The disease returns after treatment.

In addition to these stage numbers, your doctor may also describe the stage as A or B:

• A: You have not had weight loss, drenching night sweats, or fevers.

• B: You have had weight loss, drenching night sweats, or fevers.

If you have swollen lymph nodes or another symptom that suggests Hodgkin lymphoma, your doctor will try to find out what’s causing the problem. Your doctor may ask about your personal and family medical history.

You may have some of the following exams and tests:

• Physical exam: Your doctor checks for swollen lymph nodes in your neck, underarms, and groin. Your doctor also checks for a swollen spleen or liver.

• Blood tests: The lab does a complete blood count to check the number of white blood cells and other cells and substances.

• Chest x-rays: X-ray pictures may show swollen lymph nodes or other signs of disease in your chest.

• Biopsy: A biopsy is the only sure way to diagnose Hodgkin lymphoma. Your doctor may remove an entire lymph node (excisional biopsy) or only part of a lymph node (incisional biopsy). A thin needle (fine needle aspiration) usually cannot remove a large enough sample for the pathologist to diagnose Hodgkin lymphoma. Removing an entire lymph node is best.

The pathologist uses a microscope to check the tissue for Hodgkin lymphoma cells. A person with Hodgkin lymphoma usually has large, abnormal cells known as Reed-Sternberg cells. They are not found in people with non-Hodgkin lymphoma. See the photo of a Reed-Sternberg cell.

Hodgkin lymphoma is a cancer that begins in cells  of the immune system. The immune system fights infections  and other diseases.

Hodgkin lymphoma can start almost anywhere. Usually, it's first found in a lymph node above the diaphragm, the thin muscle that separates the chest from the abdomen. But Hodgkin lymphoma also may be found in a group of lymph nodes. Sometimes it starts in other parts of the lymphatic system.
Hodgkin Lymphoma Cells

Hodgkin lymphoma begins when a lymphocyte (usually a B cell) becomes abnormal. The abnormal cell is called a Reed-Sternberg cell. (See photo below.)

The Reed-Sternberg cell divides to make copies of itself. The new cells divide again and again, making more and more abnormal cells. The abnormal cells don't die when they should. They don't protect the body from infections or other diseases. The buildup of extra cells often forms a mass of tissue called a growth or tumor.

Visit the National Cancer Institute where this information and more can be found about  Hodgkin Lymphoma or ask your cancer care team questions about your individual situation.

Lo que usted necesita saber sobre el linfoma de Hodgkin.

Your doctor can describe your treatment choices and the expected results. You and your doctor can work together to develop a treatment plan that meets your needs.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat non-Hodgkin lymphoma include hematologists, medical oncologists, and radiation oncologists. Your doctor may suggest that you choose an oncologist who specializes in the treatment of lymphoma. Often, such doctors are associated with major academic centers. Your health care team may also include an oncology nurse and a registered dietitian.

The choice of treatment depends mainly on the following:

• The type of non-Hodgkin lymphoma (for example, follicular lymphoma)

• Its stage (where the lymphoma is found)

• How quickly the cancer is growing (whether it is indolent or aggressive lymphoma)

• Your age

• Whether you have other health problems

If you have indolent non-Hodgkin lymphoma without symptoms, you may not need treatment for the cancer right away. The doctor watches your health closely so that treatment can start when you begin to have symptoms. Not getting cancer treatment right away is called watchful waiting.

If you have indolent lymphoma with symptoms, you will probably receive chemotherapy and biological therapy. Radiation therapy may be used for people with Stage I or Stage II lymphoma.

If you have aggressive lymphoma, the treatment is usually chemotherapy and biological therapy. Radiation therapy also may be used.

If non-Hodgkin lymphoma comes back after treatment, doctors call this a relapse or recurrence. People with lymphoma that comes back after treatment may receive high doses of chemotherapy, radiation therapy, or both, followed by stem cell transplantation.

Watchful Waiting

People who choose watchful waiting put off having cancer treatment until they have symptoms. Doctors sometimes suggest watchful waiting for people with indolent lymphoma. People with indolent lymphoma may not have problems that require cancer treatment for a long time. Sometimes the tumor may even shrink for a while without therapy. By putting off treatment, they can avoid the side effects of chemotherapy or radiation therapy.

If you and your doctor agree that watchful waiting is a good idea, the doctor will check you regularly (every 3 months). You will receive treatment if symptoms occur or get worse.

Some people do not choose watchful waiting because they don’t want to worry about having cancer that is not treated. Those who choose watchful waiting but later become worried should discuss their feelings with the doctor.

Chemotherapy

Chemotherapy for lymphoma uses drugs to kill lymphoma cells. It is called systemic therapy because the drugs travel through the bloodstream. The drugs can reach lymphoma cells in almost all parts of the body.

You may receive chemotherapy by mouth, through a vein, or in the space around the spinal cord. Treatment is usually in an outpatient part of the hospital, at the doctor’s office, or at home. Some people need to stay in the hospital during treatment.

Chemotherapy is given in cycles. You have a treatment period followed by a rest period. The length of the rest period and the number of treatment cycles depend on the stage of your disease and on the anticancer drugs used.

If you have lymphoma in the stomach caused by H. pylori infection, your doctor may treat this lymphoma with antibiotics. After the drug cures the infection, the lymphoma also may go away.

Biological Therapies

People with certain types of non-Hodgkin lymphoma may have biological therapy. This type of treatment helps the immune system fight cancer.

Monoclonal antibodies are the type of biological therapy used for lymphoma. They are proteins made in the lab that can bind to cancer cells. They help the immune system kill lymphoma cells. People receive this treatment through a vein at the doctor’s office, clinic, or hospital.

Radiation Therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill lymphoma cells. It can shrink tumors and help control pain.
Two types of radiation therapy are used for people with lymphoma:

• External radiation: A large machine aims the rays at the part of the body where lymphoma cells have collected. This is local therapy because it affects cells in the treated area only. Most people go to a hospital or clinic for treatment 5 days a week for several weeks.

• Systemic radiation: Some people with lymphoma receive an injection of radioactive material that travels throughout the body. The radioactive material is bound to monoclonal antibodies that seek out lymphoma cells. The radiation destroys the lymphoma cells.

Stem Cell Transplantation

If lymphoma returns after treatment, you may receive stem cell transplantation. A transplant of your own blood-forming stem cells allows you to receive high doses of chemotherapy, radiation therapy, or both. The high doses destroy both lymphoma cells and healthy blood cells in the bone marrow.

Stem cell transplants take place in the hospital. After you receive high-dose treatment, healthy blood-forming stem cells are given to you through a flexible tube placed in a large vein in your neck or chest area. New blood cells develop from the transplanted stem cells.
The stem cells may come from your own body or from a donor: :

• Autologous stem cell transplantation: This type of transplant uses your own stem cells. Your stem cells are removed before high-dose treatment. The cells may be treated to kill lymphoma cells that may be present. The stem cells are frozen and stored. After you receive high-dose treatment, the stored stem cells are thawed and returned to you.

• Allogeneic stem cell transplantation: Sometimes healthy stem cells from a donor are available. Your brother, sister, or parent may be the donor. Or the stem cells may come from an unrelated donor. Doctors use blood tests to be sure the donor’s cells match your cells.

• Syngeneic stem cell transplantation: This type of transplant uses stem cells from a patient’s healthy identical twin.

Your doctor needs to know the extent (stage) of non-Hodgkin lymphoma to plan the best treatment. Staging is a careful attempt to find out what parts of the body are affected by the disease.

Lymphoma usually starts in a lymph node. It can spread to nearly any other part of the body. For example, it can spread to the liver, lungs, bone, and bone marrow.

Staging may involve one or more of the following tests:

• Bone marrow biopsy: The doctor uses a thick needle to remove a small sample of bone and bone marrow from your hipbone or another large bone. Local anesthesia can help control pain. A pathologist looks for lymphoma cells in the sample.

• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your head, neck, chest, abdomen, or pelvis. You may receive an injection of contrast material. Also, you may be asked to drink another type of contrast material. The contrast material makes it easier for the doctor to see swollen lymph nodes and other abnormal areas on the x-ray.

• MRI: Your doctor may order MRI pictures of your spinal cord, bone marrow, or brain. MRI uses a powerful magnet linked to a computer. It makes detailed pictures of tissue on a computer screen or film.

• Ultrasound: An ultrasound device sends out sound waves that you cannot hear. A small hand-held device is held against your body. The waves bounce off nearby tissues, and a computer uses the echoes to create a picture. Tumors may produce echoes that are different from the echoes made by healthy tissues. The picture can show possible tumors.

• Spinal tap: The doctor uses a long, thin needle to remove fluid from the spinal column. Local anesthesia can help control pain. You must lie flat for a few hours afterward so that you don’t get a headache. The lab checks the fluid for lymphoma cells or other problems.

• PET scan: You receive an injection of a small amount of radioactive sugar. A machine makes computerized pictures of the sugar being used by cells in your body. Lymphoma cells use sugar faster than normal cells, and areas with lymphoma look brighter on the pictures.

The stage is based on where lymphoma cells are found (in the lymph nodes or in other organs or tissues). The stage also depends on how many areas are affected. The stages of non-Hodgkin lymphoma are as follows:

• Stage I: The lymphoma cells are in one lymph node group (such as in the neck or underarm). Or, if the abnormal cells are not in the lymph nodes, they are in only one part of a tissue or organ (such as the lung, but not the liver or bone marrow).

• Stage II: The lymphoma cells are in at least two lymph node groups on the same side of (either above or below) the diaphragm. (See the picture of the diaphragm.) Or, the lymphoma cells are in one part of an organ and the lymph nodes near that organ (on the same side of the diaphragm). There may be lymphoma cells in other lymph node groups on the same side of the diaphragm.

• Stage III: The lymphoma is in lymph nodes above and below the diaphragm. It also may be found in one part of a tissue or an organ near these lymph node groups.

• Stage IV: Lymphoma cells are found in several parts of one or more organs or tissues (in addition to the lymph nodes). Or, it is in the liver, blood, or bone marrow.

• Recurrent: The disease returns after treatment.

In addition to these stage numbers, your doctor may also describe the stage as A or B:

• A: You have not had weight loss, drenching night sweats, or fevers.

• B: You have had weight loss, drenching night sweats, or fevers.

This information is about non-Hodgkin lymphoma, a cancer that starts in the immune system. Non-Hodgkin lymphoma is also called NHL.

Non-Hodgkin lymphoma begins when a lymphocyte (usually a B cell) becomes abnormal. The abnormal cell divides to make copies of itself. The new cells divide again and again, making more and more abnormal cells. The abnormal cells don't die when they should. They don't protect the body from infections or other diseases. The buildup of extra cells often forms a mass of tissue called a growth or tumor.

Because lymphatic tissue is in many parts of the body, Hodgkin lymphoma can start almost anywhere. Usually, it's first found in a lymph node.

When lymphoma is found, the pathologist reports the type. There are many types of lymphoma. The most common types are diffuse large B-cell lymphoma and follicular lymphoma.

Lymphomas may be grouped by how quickly they are likely to grow:

• Indolent (also called low-grade) lymphomas grow slowly. They tend to cause few symptoms.

• Aggressive (also called intermediate-grade and high-grade) lymphomas grow and spread more quickly. They tend to cause severe symptoms. Over time, many indolent lymphomas become aggressive lymphomas.

It’s a good idea to get a second opinion about the type of lymphoma that you have. The treatment plan varies by the type of lymphoma. A pathologist at a major referral center can review your biopsy. See the Second Opinion section for more information.

Visit the National Cancer Institute where this information and more can be found about Non Hodgkin Lymphoma or ask your cancer care team questions about your individual situation.

Lo que usted necesita saber sobre el linfoma no Hodgkin.

People with leukemia have many treatment options. The options are watchful waiting, chemotherapy, targeted therapy, biological therapy, radiation therapy, and stem cell transplant. If your spleen is enlarged, your doctor may suggest surgery to remove it. Sometimes a combination of these treatments is used.

The choice of treatment depends mainly on the following:

• The type of leukemia (acute or chronic)
• Your age
• Whether leukemia cells were found in your cerebrospinal fluid

It also may depend on certain features of the leukemia cells. Your doctor also considers your symptoms and general health.

People with acute leukemia need to be treated right away. The goal of treatment is to destroy signs of leukemia in the body and make symptoms go away. This is called a remission. After people go into remission, more therapy may be given to prevent a relapse. This type of therapy is called consolidation therapy or maintenance therapy. Many people with acute leukemia can be cured.

If you have chronic leukemia without symptoms, you may not need cancer treatment right away. Your doctor will watch your health closely so that treatment can start when you begin to have symptoms. Not getting cancer treatment right away is called watchful waiting.

When treatment for chronic leukemia is needed, it can often control the disease and its symptoms. People may receive maintenance therapy to help keep the cancer in remission, but chronic leukemia can seldom be cured with chemotherapy. However, stem cell transplants offer some people with chronic leukemia the chance for cure.

Your doctor can describe your treatment choices, the expected results, and the possible side effects. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.

You may want to talk with your doctor about taking part in a clinical trial, a research study of new treatment methods. See the Taking Part in Cancer Research section.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat leukemia include hematologists, medical oncologists, and radiation oncologists. Pediatric oncologists and hematologists treat childhood leukemia. Your health care team may also include an oncology nurse and a registered dietitian.

Whenever possible, people should be treated at a medical center that has doctors experienced in treating leukemia. If this isn’t possible, your doctor may discuss the treatment plan with a specialist at such a center.

Before treatment starts, ask your health care team to explain possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.

Watchful Waiting

People with chronic lymphocytic leukemia who do not have symptoms may be able to put off having cancer treatment. By delaying treatment, they can avoid the side effects of treatment until they have symptoms.

If you and your doctor agree that watchful waiting is a good idea, you’ll have regular checkups (such as every 3 months). You can start treatment if symptoms occur.

Although watchful waiting avoids or delays the side effects of cancer treatment, this choice has risks. It may reduce the chance to control leukemia before it gets worse.

You may decide against watchful waiting if you don’t want to live with an untreated leukemia. Some people choose to treat the cancer right away.

If you choose watchful waiting but grow concerned later, you should discuss your feelings with your doctor. A different approach is nearly always available.

Chemotherapy

Many people with leukemia are treated with chemotherapy. Chemotherapy uses drugs to destroy leukemia cells.

Depending on the type of leukemia, you may receive a single drug or a combination of two or more drugs.

You may receive chemotherapy in several different ways:

• By mouth: Some drugs are pills that you can swallow.

• Into a vein (IV): The drug is given through a needle or tube inserted into a vein.

• Through a catheter (a thin, flexible tube): The tube is placed in a large vein, often in the upper chest. A tube that stays in place is useful for patients who need many IV treatments. The health care professional injects drugs into the catheter, rather than directly into a vein. This method avoids the need for many injections, which can cause discomfort and injure the veins and skin.

• Into the cerebrospinal fluid: If the pathologist finds leukemia cells in the fluid that fills the spaces in and around the brain and spinal cord, the doctor may order intrathecal chemotherapy. The doctor injects drugs directly into the cerebrospinal fluid. Intrathecal chemotherapy is given in two ways:
  • Into the spinal fluid: The doctor injects the drugs into the spinal fluid.
  • Under the scalp: Children and some adult patients receive chemotherapy through a special catheter called an Ommaya reservoir. The doctor places the catheter under the scalp. The doctor injects the drugs into the catheter. This method avoids the pain of injections into the spinal fluid.

Intrathecal chemotherapy is used because many drugs given by IV or taken by mouth can’t pass through the tightly packed blood vessel walls found in the brain and spinal cord. This network of blood vessels is known as the blood-brain barrier.

Chemotherapy is usually given in cycles. Each cycle has a treatment period followed by a rest period.

You may have your treatment in a clinic, at the doctor’s office, or at home. Some people may need to stay in the hospital for treatment.

Targeted Therapy

People with chronic myeloid leukemia and some with acute lymphoblastic leukemia may receive drugs called targeted therapy. Imatinib (Gleevec) tablets were the first targeted therapy approved for chronic myeloid leukemia. Other targeted therapy drugs are now used too.

Targeted therapies use drugs that block the growth of leukemia cells. For example, a targeted therapy may block the action of an abnormal protein that stimulates the growth of leukemia cells.

Biological Therapy

Some people with leukemia receive drugs called biological therapy. Biological therapy for leukemia is treatment that improves the body’s natural defenses against the disease.

One type of biological therapy is a substance called a monoclonal antibody. It’s given by IV infusion. This substance binds to the leukemia cells. One kind of monoclonal antibody carries a toxin that kills the leukemia cells. Another kind helps the immune system destroy leukemia cells.

For some people with chronic myeloid leukemia, the biological therapy is a drug called interferon. It is injected under the skin or into a muscle. It can slow the growth of leukemia cells.

You may have your treatment in a clinic, at the doctor’s office, or in the hospital. Other drugs may be given at the same time to prevent side effects.

Doctors sometimes find leukemia after a routine blood test. If you have symptoms that suggest leukemia, your doctor will try to find out what’s causing the problems. Your doctor may ask about your personal and family medical history.

You may have one or more of the following tests:

• Physical exam: Your doctor checks for swollen lymph nodes, spleen, or liver.

• Blood tests: The lab does a complete blood count to check the number of white blood cells, red blood cells, and platelets. Leukemia causes a very high level of white blood cells. It may also cause low levels of platelets and hemoglobin, which is found inside red blood cells.

• Biopsy: Your doctor removes tissue to look for cancer cells. A biopsy is the only sure way to know whether leukemia cells are in your bone marrow. Before the sample is taken, local anesthesia is used to numb the area. This helps reduce the pain. Your doctor removes some bone marrow from your hipbone or another large bone. A pathologist uses a microscope to check the tissue for leukemia cells.

There are two ways your doctor can obtain bone marrow. Some people will have both procedures during the same visit:

• Bone marrow aspiration: The doctor uses a thick, hollow needle to remove samples of bone marrow.
• Bone marrow biopsy: The doctor uses a very thick, hollow needle to remove a small piece of bone and bone marrow.

Other Tests

The tests that your doctor orders for you depend on your symptoms and type of leukemia. You may have other tests:

• Cytogenetics: The lab looks at the chromosomes of cells from samples of blood, bone marrow, or lymph nodes. If abnormal chromosomes are found, the test can show what type of leukemia you have. For example, people with CML have an abnormal chromosome called the Philadelphia chromosome.
• Spinal tap: Your doctor may remove some of the cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord). The doctor uses a long, thin needle to remove fluid from the lower spine. The procedure takes about 30 minutes and is performed with local anesthesia. You must lie flat for several hours afterward to keep from getting a headache. The lab checks the fluid for leukemia cells or other signs of problems.
• Chest x-ray: An x-ray can show swollen lymph nodes or other signs of disease in your chest.

Your blood is living tissue made up of liquid and solids. The liquid part, called plasma, is made of water, salts and protein. Over half of your blood is plasma. The solid part of your blood contains red blood cells, white blood cells and platelets.

Red blood cells deliver oxygen from your lungs to your tissues and organs. White blood cells fight infection and are part of your body's defense system. Platelets help blood to clot. Bone marrow, the spongy material inside your bones, makes new blood cells. Blood cells constantly die and your body makes new ones. Red blood cells live about 120 days, platelets 6 days and white cells less than one day.

There are many types of blood disorders, including: bleeding disorders, platelet disorders, bone marrow disorders, hemophilia and anemia. There are also several cancers of the blood including lymphomas, leukemia and myeloma.

Cancer Care Centers of South Texas have been recognized nationally for expertise in the diagnosis, treatment and research of myelodysplasia and is designated as a "Center of Excellence" by the Myelodysplastic Syndromes Foundation.   The Cancer Care Centers of South Texas MDS Center of Excellence medical director is Roger M. Lyons, MD, FACP.

You may read more about bleeding and clotting disorders and management and treatments available through the Anticoagulation Clinic of North America (ACNA) section of this website.  ACNA clinics are located at 4411 Medical Drive, Suite 100 in San Antonio, TX, 124 E. Bandera Rd., in Boerne, TX, 1448 E. Common St. in New Braunfels, TX and 1025 Garner Field Rd. in Uvalde, TX.  Please call 210-595-5300 for more information about the Anticoagulation Clinic of North America.

Leukemia is cancer that starts in the tissues that forms blood.

The types of leukemia can be grouped based on how quickly the disease develops and gets worse. Leukemia is either chronic (which usually gets worse slowly) or acute (which usually gets worse quickly):

• Chronic leukemia: Early in the disease, the leukemia cells can still do some of the work of normal white blood cells. People may not have any symptoms at first. Doctors often find chronic leukemia during a routine checkup – before there are any symptoms. Slowly, chronic leukemia gets worse. As the number of leukemia cells in the blood increases, people get symptoms, such as swollen lymph nodes or infections. When symptoms do appear, they are usually mild at first and get worse gradually.

• Acute leukemia: The leukemia cells can’t do any of the work of normal white blood cells. The number of leukemia cells increases rapidly. Acute leukemia usually worsens quickly. 

Lo que usted necesita saber sobre la leucemia.

Treatment Options by Stage

Stage 0 (Papillary Carcinoma and Carcinoma in Situ)

Treatment of stage 0 may include the following:

• Transurethral resection with fulguration.
• Transurethral resection with fulguration followed by intravesical biologic therapy or chemotherapy.
• Segmental cystectomy.
• Radical cystectomy.
• A clinical trial of photodynamic therapy.
• A clinical trial of biologic therapy.
• A clinical trial of chemoprevention therapy given after treatment so the condition will not recur (come back).

Stage I
Treatment of stage I bladder cancer may include the following:

• Transurethral resection with fulguration.
• Transurethral resection with fulguration followed by intravesical biologic therapy or chemotherapy.
• Segmental or radical cystectomy.
• Radiation implants with or without external radiation therapy.
• A clinical trial of chemoprevention therapy given after treatment to stop cancer from recurring (coming back).

Stage II
Treatment of stage II bladder cancer may include the following:

• Radical cystectomy with or without surgery to remove pelvic lymph nodes.
• Combination chemotherapy followed by radical cystectomy.
• External radiation therapy combined with chemotherapy.
• Radiation implants before or after external radiation therapy.
• Transurethral resection with fulguration.
• Segmental cystectomy.

Stage III
Treatment of stage III bladder cancer may include the following:

• Radical cystectomy with or without surgery to remove pelvic lymph nodes.
• Combination chemotherapy followed by radical cystectomy.
• External radiation therapy combined with chemotherapy.
• External radiation therapy with radiation implants.
• Segmental cystectomy.

Stage IV
Treatment of stage IV bladder cancer may include the following:

• Radical cystectomy with surgery to remove pelvic lymph nodes.
• External radiation therapy (may be as palliative therapy to relieve symptoms and improve quality of life).
• Urinary diversion as palliative therapy to relieve symptoms and improve quality of life.
• Cystectomy as palliative therapy to relieve symptoms and improve quality of life.
• Chemotherapy alone or after local treatment (surgery or radiation therapy).

The following stages are used for bladder cancer:

Stage 0 (Papillary Carcinoma and Carcinoma in Situ)

In stage 0, abnormal cells are found in tissue lining the inside of the bladder. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is divided into stage 0a and stage 0is, depending on the type of the tumor:

• Stage 0a is also called papillary carcinoma, which may look like tiny mushrooms growing from the lining of the bladder.
• Stage 0is is also called carcinoma in situ, which is a flat tumor on the tissue lining the inside of the bladder.

Stage I

In stage I, cancer has formed and spread to the layer of tissue under the inner lining of the bladder.

Stage II

In stage II, cancer has spread to either the inner half or outer half of the muscle wall of the bladder.

Stage III

In stage III, cancer has spread from the bladder to the fatty layer of tissue surrounding it, and may have spread to the reproductive organs (prostate, uterus, vagina).

Stage IV

In stage IV, cancer has spread from the bladder to the wall of the abdomen or pelvis. Cancer may have spread to one or more lymph nodes or to other parts of the body.

Tests that examine the urine, vagina, or rectum are used to help detect (find) and diagnose bladder cancer.

The following tests and procedures may be used:

• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells.
• Internal exam: An exam of the vagina and/or rectum. The doctor inserts gloved fingers into the vagina and/or rectum to feel for lumps.
• Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer is present in these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
• Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
• Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. A biopsy for bladder cancer is usually done during cystoscopy. It may be possible to remove the entire tumor during biopsy.
• Urine cytology: Examination of urine under a microscope to check for abnormal cells.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on the following:

• The stage of the cancer (whether it is superficial or invasive bladder cancer, and whether it has spread to other places in the body). Bladder cancer in the early stages can often be cured.
• The type of bladder cancer cells and how they look under a microscope.
• The patient’s age and general health.

Treatment options depend on the stage of bladder cancer.

There are three types of bladder cancer that begin in cells in the lining of the bladder. These cancers are named for the type of cells that become malignant (cancerous):

• Transitional cell carcinoma: Cancer that begins in cells in the innermost tissue layer of the bladder. These cells are able to stretch when the bladder is full and shrink when it is emptied. Most bladder cancers begin in the transitional cells.
• Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that may form in the bladder after long-term infection or irritation.
• Adenocarcinoma: Cancer that begins in glandular (secretory) cells that may form in the bladder after long-term irritation and inflammation.

Cancer that is confined to the lining of the bladder is called superficial bladder cancer. Cancer that begins in the transitional cells may spread through the lining of the bladder and invade the muscle wall of the bladder or spread to nearby organs and lymph nodes; this is called invasive bladder cancer.

Visit the National Cancer Institute where this information and more can be found about Bladder Cancer or ask your cancer care team questions about your individual situation.

Lo que usted necesita saber sobre el cáncer de al vejiga.

People with thyroid cancer have many treatment options. Treatment usually begins within a few weeks after the diagnosis, but you will have time to talk with your doctor about treatment choices and get a second opinion.
The choice of treatment depends on:

• the type of thyroid cancer (papillary, follicular, medullary, or anaplastic)
• the size of the nodule
• your age
• whether the cancer has spread

You and your doctor can work together to develop a treatment plan that meets your needs.

Your doctor can describe your treatment choices and the expected results. Thyroid cancer may be treated with surgery, thyroid hormone treatment, radioactive iodine therapy, external radiation therapy, or chemotherapy. Most patients receive a combination of treatments. For example, the standard treatment for papillary cancer is surgery, thyroid hormone treatment, and radioactive iodine therapy. Although external radiation therapy and chemotherapy are not often used, when they are, the treatments may be combined.

Surgery and external radiation therapy are local therapies. They remove or destroy cancer in the thyroid. When thyroid cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.

Thyroid hormone treatment, radioactive iodine therapy, and chemotherapy are systemic therapies. Systemic therapies enter the bloodstream and destroy or control cancer throughout the body.

Surgery
Most people with thyroid cancer have surgery. The surgeon removes all or part of the thyroid. The type of surgery depends on the type and stage of thyroid cancer, the size of the nodule, and your age.

• Total thyroidectomy: This surgery can be used for all types of thyroid cancer. The surgeon removes all of the thyroid through an incision in the neck. If the surgeon is not able to remove all of the thyroid tissue, it can be destroyed by radioactive iodine therapy later.

Nearby lymph nodes also may be removed. If cancer has invaded tissue within the neck, the surgeon may remove nearby tissue. If cancer has spread outside the neck, surgery, radioactive iodine therapy, or external radiation therapy may be used to treat those areas.

• Lobectomy: Some people with follicular or papillary thyroid cancer may have only part of the thyroid removed. The surgeon removes one lobe and the isthmus. Some people who have a lobectomy later have a second surgery to remove the rest of the thyroid. Less often, the remaining thyroid tissue is destroyed by radioactive iodine therapy.

The time it takes to heal after surgery is different for each person. You may be uncomfortable for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.

Surgery for thyroid cancer removes the cells that make thyroid hormone. After surgery, nearly all people need to take pills to replace the natural thyroid hormone. You will need thyroid hormone pills for the rest of your life.

If the surgeon removes the parathyroid glands, you may need to take calcium and vitamin D pills for the rest of your life.

Thyroid Hormone Treatment

After surgery to remove part or all of the thyroid, nearly everyone needs to take pills to replace the natural thyroid hormone. However, thyroid hormone pills are also used as part of the treatment for papillary or follicular thyroid cancer. Thyroid hormone slows the growth of thyroid cancer cells left in the body after surgery.

Thyroid hormone pills seldom cause side effects. Your doctor gives you blood tests to make sure you’re getting the right dose of thyroid hormone. Too much thyroid hormone may cause you to lose weight and feel hot and sweaty. It may also cause a fast heart rate, chest pain, cramps, and diarrhea. Too little thyroid hormone may cause you to gain weight, feel cold and tired, and have dry skin and hair. If you have side effects, your doctor can adjust your dose of thyroid hormone.

Radioactive Iodine Therapy

Radioactive iodine (I-131) therapy is a treatment for papillary or follicular thyroid cancer. It kills thyroid cancer cells and normal thyroid cells that remain in the body after surgery.

People with medullary thyroid cancer or anaplastic thyroid cancer usually do not receive I-131 therapy. These types of thyroid cancer rarely respond to I-131 therapy.

Even people who are allergic to iodine can take I-131 therapy safely. The therapy is given as a liquid or capsule that you swallow. I-131 goes into the bloodstream and travels to thyroid cancer cells throughout the body. When thyroid cancer cells take in enough I-131, they die.

Many people get I-131 therapy in a clinic or in the outpatient area of a hospital and can go home afterward. Some people have to stay in the hospital for one day or longer. Ask your health care team to explain how to protect family members and coworkers from being exposed to the radiation.

Most radiation from I-131 is gone in about one week. Within three weeks, only traces of I-131 remain in the body.

During treatment, you can help protect your bladder and other healthy tissues by drinking a lot of fluids. Drinking fluids helps I-131 pass out of the body faster.

Some people have mild nausea the first day of I-131 therapy. A few people have swelling and pain in the neck where thyroid cells remain. If thyroid cancer cells have spread outside the neck, those areas may be painful too.

You may have a dry mouth or lose your sense of taste or smell for a short time after I-131 therapy. Chewing sugar-free gum or sucking on sugar-free hard candy may help.

A rare side effect in men who receive a high dose of I-131 is loss of fertility. In women, I-131 may not cause loss of fertility, but some doctors advise women to avoid getting pregnant for one year after a high dose of I-131.

Researchers have reported that a very small number of patients may develop a second cancer years after treatment with a high dose of I-131. See the “Follow-up Care” section for information about checkups after treatment.

A high dose of I-131 also kills normal thyroid cells, which make thyroid hormone. After radioactive iodine therapy, you need to take thyroid hormone pills to replace the natural hormone.

Radiation Therapy
External Radiation Therapy

External radiation therapy (also called radiotherapy) is a treatment for any type of thyroid cancer that can’t be treated with surgery or I-131 therapy. It’s also used for cancer that returns after treatment or to treat bone pain from cancer that has spread.

External radiation therapy uses high-energy rays to kill cancer cells. A large machine directs radiation at the neck or other tissues where cancer has spread.

Most patients go to the hospital or clinic for their treatment, usually 5 days a week for several weeks. Each treatment takes only a few minutes.

Chemotherapy

Chemotherapy is a treatment for anaplastic thyroid cancer. It’s sometimes used to relieve symptoms of medullary thyroid cancer or other thyroid cancers.

Chemotherapy uses drugs to kill cancer cells. The drugs are usually given by injection into a vein. They enter the bloodstream and can affect cancer cells all over the body.

You may have treatment in a clinic, at the doctor’s office, or at home. Some people may need to stay in the hospital during treatment.

To plan the best treatment, your doctor needs to learn the extent (stage) of the disease. Staging is a careful attempt to find out the size of the nodule, whether the cancer has spread, and if so, to what parts of the body.

Thyroid cancer spreads most often to the lymph nodes, lungs, and bones. When cancer spreads from its original place to another part of the body, the new tumor has the same kind of cancer cells and the same name as the original cancer. For example, if thyroid cancer spreads to the lungs, the cancer cells in the lungs are actually thyroid cancer cells. The disease is metastatic thyroid cancer, not lung cancer. For that reason, it’s treated as thyroid cancer, not lung cancer. Doctors call the new tumor “distant” or metastatic disease.

Staging may involve one or more of these tests:

• Ultrasound: An ultrasound exam of your neck may show whether cancer has spread to lymph nodes or other tissues near your thyroid.

• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of areas inside your body. A CT scan may show whether cancer has spread to lymph nodes, other areas in your neck, or your chest.

• MRI: MRI uses a powerful magnet linked to a computer. It makes detailed pictures of tissue. Your doctor can view these pictures on a screen or print them on film. MRI may show whether cancer has spread to lymph nodes or other areas.

• Chest x-ray: X-rays of your chest may show whether cancer has spread to the lungs.

• Whole body scan: You may have a whole body scan to see if cancer has spread from the thyroid to other parts of the body. You get a small amount of a radioactive substance. The substance travels through the bloodstream. Thyroid cancer cells in other organs or the bones take up the substance. Thyroid cancer that has spread may show up on a whole body scan.

If you have symptoms that suggest thyroid cancer, your doctor will help you find out whether they are from cancer or some other cause. Your doctor will ask you about your personal and family medical history. You may have one or more of the following tests:

• Physical exam: Your doctor feels your thyroid for lumps (nodules). Your doctor also checks your neck and nearby lymph nodes for growths or swelling.

• Blood tests: Your doctor may check for abnormal levels of thyroid-stimulating hormone (TSH) in the blood. Too much or too little TSH means the thyroid is not working well. If your doctor thinks you may have medullary thyroid cancer, you may be checked for a high level of calcitonin and have other blood tests.

• Ultrasound: An ultrasound device uses sound waves that people cannot hear. The device aims sound waves at the thyroid, and a computer creates a picture of the waves that bounce off the thyroid. The picture can show thyroid nodules that are too small to be felt. The doctor uses the picture to learn the size and shape of each nodule and whether the nodules are solid or filled with fluid. Nodules that are filled with fluid are usually not cancer. Nodules that are solid may be cancer.

• Thyroid scan: Your doctor may order a scan of your thyroid. You swallow a small amount of a radioactive substance, and it travels through the bloodstream. Thyroid cells that absorb the radioactive substance can be seen on a scan. Nodules that take up more of the substance than the thyroid tissue around them are called “hot” nodules. Hot nodules are usually not cancer. Nodules that take up less substance than the thyroid tissue around them are called “cold” nodules. Cold nodules may be cancer.

• Biopsy: A biopsy is the only sure way to diagnose thyroid cancer. A pathologist checks a sample of tissue for cancer cells with a microscope.

Your doctor may take tissue for a biopsy in one of two ways:

• Fine-needle aspiration: Most people have this type of biopsy. Your doctor removes a sample of tissue from a thyroid nodule with a thin needle. An ultrasound device can help your doctor see where to place the needle.

• Surgical biopsy: If a diagnosis cannot be made from fine-needle aspiration, a surgeon removes the whole nodule during an operation. If the doctor suspects follicular thyroid cancer, surgical biopsy may be needed for diagnosis.

There are several types of thyroid cancer:

* Papillary thyroid cancer: In the United States, this type makes up about 80 percent of all thyroid cancers. It begins in follicular cells and grows slowly. If diagnosed early, most people with papillary thyroid cancer can be cured.

* Follicular thyroid cancer: This type makes up about 15 percent of all thyroid cancers. It begins in follicular cells and grows slowly. If diagnosed early, most people with follicular thyroid cancer can be treated successfully.

* Medullary thyroid cancer: This type makes up about 3 percent of all thyroid cancers. It begins in the C cells of the thyroid. Cancer that starts in the C cells can make abnormally high levels of calcitonin. Medullary thyroid cancer tends to grow slowly. It can be easier to control if it's found and treated before it spreads to other parts of the body.

* Anaplastic thyroid cancer: This type makes up about 2 percent of all thyroid cancers. It begins in the follicular cells of the thyroid. The cancer cells tend to grow and spread very quickly. Anaplastic thyroid cancer is very hard to control.

Visit the National Cancer Institute where this information and more can be found about Thyroid Cancer or ask your cancer care team questions about your individual situation.
 

If the biopsy shows that you have cancer, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. Staging is a careful attempt to find out whether the tumor has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body. Cervical cancer spreads most often to nearby tissues in the pelvis, lymph nodes, or the lungs. It may also spread to the liver or bones.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of cancer cells and the same name as the original tumor. For example, if cervical cancer spreads to the lungs, the cancer cells in the lungs are actually cervical cancer cells. The disease is metastatic cervical cancer, not lung cancer. For that reason, it’s treated as cervical cancer, not lung cancer. Doctors call the new tumor “distant” or metastatic disease.

Your doctor will do a pelvic exam, feel for swollen lymph nodes, and may remove additional tissue. To learn the extent of disease, the doctor may order some of the following tests:

• Chest x-rays: X-rays often can show whether cancer has spread to the lungs.

• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your organs. A tumor in the liver, lungs, or elsewhere in the body can show up on the CT scan. You may receive contrast material by injection in your arm or hand, by mouth, or by enema. The contrast material makes abnormal areas easier to see.

• MRI: A powerful magnet linked to a computer is used to make detailed pictures of your pelvis and abdomen. The doctor can view these pictures on a monitor and can print them on film. An MRI can show whether cancer has spread. Sometimes contrast material makes abnormal areas show up more clearly on the picture.

• PET scan: You receive an injection of a small amount of radioactive sugar. A machine makes computerized pictures of the sugar being used by cells in your body. Cancer cells use sugar faster than normal cells, and areas with cancer look brighter on the pictures.

The stage is based on where cancer is found. These are the stages of invasive cervical cancer:

• Stage I: The tumor has invaded the cervix beneath the top layer of cells. Cancer cells are found only in the cervix.

• Stage II: The tumor extends to the upper part of the vagina. It may extend beyond the cervix into nearby tissues toward the pelvic wall (the lining of the part of the body between the hips). The tumor does not invade the lower third of the vagina or the pelvic wall.

• Stage III: The tumor extends to the lower part of the vagina. It may also have invaded the pelvic wall. If the tumor blocks the flow of urine, one or both kidneys may not be working well.

• Stage IV: The tumor invades the bladder or rectum. Or the cancer has spread to other parts of the body.

• Recurrent cancer: The cancer was treated, but has returned after a period of time during which it could not be detected. The cancer may show up again in the cervix or in other parts of the body.

Women with cervical cancer have many treatment options. The options are surgery, radiation therapy, chemotherapy, or a combination of methods.

The choice of treatment depends mainly on the size of the tumor and whether the cancer has spread. The treatment choice may also depend on whether you would like to become pregnant someday.

Surgery

Surgery is an option for women with Stage I or II cervical cancer. The surgeon removes tissue that may contain cancer cells:

• Radical trachelectomy: The surgeon removes the cervix, part of the vagina, and the lymph nodes in the pelvis. This option is for a small number of women with small tumors who want to try to get pregnant later on.

• Total hysterectomy: The surgeon removes the cervix and uterus.

• Radical hysterectomy: The surgeon removes the cervix, some tissue around the cervix, the uterus, and part of the vagina.

With either total or radical hysterectomy, the surgeon may remove other tissues:

• Fallopian tubes and ovaries: The surgeon may remove both fallopian tubes and ovaries. This surgery is called a salpingo-oophorectomy.

• Lymph nodes: The surgeon may remove the lymph nodes near the tumor to see if they contain cancer. If cancer cells have reached the lymph nodes, it means the disease may have spread to other parts of the body.

Radiation Therapy

Radiation therapy (also called radiotherapy) is an option for women with any stage of cervical cancer. Women with early stage cervical cancer may choose radiation therapy instead of surgery. It also may be used after surgery to destroy any cancer cells that remain in the area. Women with cancer that extends beyond the cervix may have radiation therapy and chemotherapy

Radiation therapy uses high-energy rays to kill cancer cells. It affects cells only in the treated area.

Doctors use two types of radiation therapy to treat cervical cancer. Some women receive both types:

• External radiation therapy: A large machine directs radiation at your pelvis or other tissues where the cancer has spread. The treatment usually is given in a hospital or clinic. You may receive external radiation 5 days a week for several weeks. Each treatment takes only a few minutes.

• Internal radiation therapy: A thin tube is placed inside the vagina. A radioactive substance is loaded into the tube. You may need to stay in the hospital while the radioactive source is in place (up to 3 days). Or the treatment session may last a few minutes, and you can go home afterward. Once the radioactive substance is removed, no radioactivity is left in your body. Internal radiation may be repeated two or more times over several weeks.

Chemotherapy


For the treatment of cervical cancer, chemotherapy is usually combined with radiation therapy. For cancer that has spread to distant organs, chemotherapy alone may be used.

Chemotherapy uses drugs to kill cancer cells. The drugs for cervical cancer are usually given through a vein (intravenous). You may receive chemotherapy in a clinic, at the doctor’s office, or at home. Some women need to stay in the hospital during treatment.

Doctors recommend that women help reduce their risk of cervical cancer by having regular Pap tests. A Pap test (sometimes called Pap smear or cervical smear) is a simple test used to look at cervical cells. Pap tests can find cervical cancer or abnormal cells that can lead to cervical cancer.

Finding and treating abnormal cells can prevent most cervical cancer. Also, the Pap test can help find cancer early, when treatment is more likely to be effective.

For most women, the Pap test is not painful. It’s done in a doctor’s office or clinic during a pelvic exam. The doctor or nurse scrapes a sample of cells from the cervix. A lab checks the cells under a microscope for cell changes. Most often, abnormal cells found by a Pap test are not cancerous. The same sample of cells may be tested for HPV infection.

If you have abnormal Pap or HPV test results, your doctor will suggest other tests to make a diagnosis:

• Colposcopy: The doctor uses a colposcope to look at the cervix. The colposcope combines a bright light with a magnifying lens to make tissue easier to see. It is not inserted into the vagina. A colposcopy is usually done in the doctor’s office or clinic.
• Biopsy: Most women have tissue removed in the doctor’s office with local anesthesia. A pathologist checks the tissue under a microscope for abnormal cells.
  • Punch biopsy: The doctor uses a sharp tool to pinch off small samples of cervical tissue.
  • LEEP: The doctor uses an electric wire loop to slice off a thin, round piece of cervical tissue.
  • Endocervical curettage: The doctor uses a curette (a small, spoon-shaped instrument) to scrape a small sample of tissue from the cervix. Some doctors may use a thin, soft brush instead of a curette.
  • Conization: The doctor removes a cone-shaped sample of tissue. A conization, or cone biopsy, lets the pathologist see if abnormal cells are in the tissue beneath the surface of the cervix. The doctor may do this test in the hospital under general anesthesia.

Removing tissue from the cervix may cause some bleeding or other discharge. The area usually heals quickly. Some women also feel some pain similar to menstrual cramps. Your doctor can suggest medicine that will help relieve your pain.

Your doctor can describe your treatment choices and the expected results. Most women have surgery and chemotherapy. Rarely, radiation therapy is used.

Cancer treatment can affect cancer cells in the pelvis, in the abdomen, or throughout the body:

• Local therapy: Surgery and radiation therapy are local therapies. They remove or destroy ovarian cancer in the pelvis. When ovarian cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.
• Intraperitoneal chemotherapy: Chemotherapy can be given directly into the abdomen and pelvis through a thin tube. The drugs destroy or control cancer in the abdomen and pelvis.
• Systemic chemotherapy: When chemotherapy is taken by mouth or injected into a vein, the drugs enter the bloodstream and destroy or control cancer throughout the body.

You may want to know how treatment may change your normal activities. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.

Surgery
The surgeon makes a long cut in the wall of the abdomen. This type of surgery is called a laparotomy. If ovarian cancer is found, the surgeon removes:

• both ovaries and fallopian tubes (salpingo-oophorectomy)
• the uterus (hysterectomy)
• the omentum (the thin, fatty pad of tissue that covers the intestines)
• nearby lymph nodes
• samples of tissue from the pelvis and abdomen

If the cancer has spread, the surgeon removes as much cancer as possible. This is called “debulking” surgery.

If you have early Stage I ovarian cancer, the extent of surgery may depend on whether you want to get pregnant and have children. Some women with very early ovarian cancer may decide with their doctor to have only one ovary, one fallopian tube, and the omentum removed.

Chemotherapy
Chemotherapy uses anticancer drugs to kill cancer cells. Most women have chemotherapy for ovarian cancer after surgery. Some women have chemotherapy before surgery.

Usually, more than one drug is given. Drugs for ovarian cancer can be given in different ways:

• By vein (IV): The drugs can be given through a thin tube inserted into a vein.
• By vein and directly into the abdomen: Some women get IV chemotherapy along with intraperitoneal (IP) chemotherapy. For IP chemotherapy, the drugs are given through a thin tube inserted into the abdomen.
• By mouth: Some drugs for ovarian cancer can be given by mouth.

Chemotherapy is given in cycles. Each treatment period is followed by a rest period. The length of the rest period and the number of cycles depend on the anticancer drugs used.

You may have your treatment in a clinic, at the doctor’s office, or at home. Some women may need to stay in the hospital during treatment.

Radiation Therapy

Radiation therapy is rarely used in the initial treatment of ovarian cancer, but it may be used to relieve pain and other problems caused by the disease. The treatment is given at a hospital or clinic. Each treatment takes only a few minutes.

This information is only about invasive cervical cancer. It's not about precancer, abnormal cells found only on the surface of the cervix, or other cervical changes. These cell changes are treated differently from invasive cervical cancer. Women with abnormal cervical cells only on the surface may want to read the NCI booklet Understanding Cervical Changes: A Health Guide for Women. It tells about abnormal cells and describes treatments.

This information and more about Cervical Cancer is provided by the National Cancer Institute, Or ask your cancer care team about your individual situation.

Lo que usted necesita saber sobre el cáncer de cérvix.

To plan the best treatment, your doctor needs to know the grade of the tumor and the extent (stage) of the disease. The stage is based on whether the tumor has invaded nearby tissues, whether the cancer has spread, and if so, to what parts of the body.

Usually, surgery is needed before staging can be complete. The surgeon takes many samples of tissue from the pelvis and abdomen to look for cancer.

Your doctor may order tests to find out whether the cancer has spread:

• CT scan: Doctors often use CT scans to make pictures of organs and tissues in the pelvis or abdomen. An x-ray machine linked to a computer takes several pictures. You may receive contrast material by mouth and by injection into your arm or hand. The contrast material helps the organs or tissues show up more clearly. Abdominal fluid or a tumor may show up on the CT scan.
• Chest x-ray: X-rays of the chest can show tumors or fluid.
• Barium enema x-ray: Your doctor may order a series of x-rays of the lower intestine. You are given an enema with a barium solution. The barium outlines the intestine on the x-rays. Areas blocked by cancer may show up on the x-rays.
• Colonoscopy: Your doctor inserts a long, lighted tube into the rectum and colon. This exam can help tell if cancer has spread to the colon or rectum.

These are the stages of ovarian cancer:

• Stage I: Cancer cells are found in one or both ovaries. Cancer cells may be found on the surface of the ovaries or in fluid collected from the abdomen.
• Stage II: Cancer cells have spread from one or both ovaries to other tissues in the pelvis. Cancer cells are found on the fallopian tubes, the uterus, or other tissues in the pelvis. Cancer cells may be found in fluid collected from the abdomen.
• Stage III: Cancer cells have spread to tissues outside the pelvis or to the regional lymph nodes. Cancer cells may be found on the outside of the liver.
• Stage IV: Cancer cells have spread to tissues outside the abdomen and pelvis. Cancer cells may be found inside the liver, in the lungs, or in other organs.

If you have a symptom that suggests ovarian cancer, your doctor must find out whether it is due to cancer or to some other cause. Your doctor may ask about your personal and family medical history.

You may have one or more of the following tests. Your doctor can explain more about each test:

• Physical exam: Your doctor checks general signs of health. Your doctor may press on your abdomen to check for tumors or an abnormal buildup of fluid (ascites). A sample of fluid can be taken to look for ovarian cancer cells.
• Pelvic exam: Your doctor feels the ovaries and nearby organs for lumps or other changes in their shape or size. A Pap test is part of a normal pelvic exam, but it is not used to collect ovarian cells. The Pap test detects cervical cancer. The Pap test is not used to diagnose ovarian cancer.
• Blood tests: Your doctor may order blood tests. The lab may check the level of several substances, including CA-125. CA-125 is a substance found on the surface of ovarian cancer cells and on some normal tissues. A high CA-125 level could be a sign of cancer or other conditions. The CA-125 test is not used alone to diagnose ovarian cancer. This test is approved by the Food and Drug Administration for monitoring a woman’s response to ovarian cancer treatment and for detecting its return after treatment.
• Ultrasound: The ultrasound device uses sound waves that people cannot hear. The device aims sound waves at organs inside the pelvis. The waves bounce off the organs. A computer creates a picture from the echoes. The picture may show an ovarian tumor. For a better view of the ovaries, the device may be inserted into the vagina (transvaginal ultrasound).
• Biopsy: A biopsy is the removal of tissue or fluid to look for cancer cells. Based on the results of the blood tests and ultrasound, your doctor may suggest surgery (a laparotomy) to remove tissue and fluid from the pelvis and abdomen. Surgery is usually needed to diagnose ovarian cancer. To learn more about surgery, see the “Treatment” section.

Although most women have a laparotomy for diagnosis, some women have a procedure known as laparoscopy. The doctor inserts a thin, lighted tube (a laparoscope) through a small incision in the abdomen. Laparoscopy may be used to remove a small, benign cyst or an early ovarian cancer. It may also be used to learn whether cancer has spread.

A pathologist uses a microscope to look for cancer cells in the tissue or fluid. If ovarian cancer cells are found, the pathologist describes the grade of the cells. Grades 1, 2, and 3 describe how abnormal the cancer cells look. Grade 1 cancer cells are not as likely as to grow and spread as Grade 3 cells.

Ovarian epithelial cancer is the most common type of ovarian cancer. It begins in the tissue that covers the ovaries. This information is not about ovarian germ cell tumors or other types of ovarian cancer. To find out more about all types of of ovarian cancer, please visit the National Cancer Institute Web site or ask your cancer care team about your individual situation.

There are different types of treatment for patients with small cell lung cancer.

Different types of treatment are available for patients with small cell lung cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Five types of standard treatment are used:

Surgery

Surgery may be used if the cancer is found in one lung and in nearby lymph nodes only. Because this type of lung cancer is usually found in both lungs, surgery alone is not often used. Occasionally, surgery may be used to help determine the patient’s exact type of lung cancer. During surgery, the doctor will also remove lymph nodes to see if they contain cancer.

Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. Prophylactic cranial irradiation (radiation therapy to the brain to reduce the risk that cancer will spread to the brain) may also be given. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Laser therapy

Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.

Endoscopic stent placement

An endoscope is a thin, tube-like instrument used to look at tissues inside the body. An endoscope has a light and a lens for viewing and may be used to place a stent in a body structure to keep the structure open. Endoscopic stent placement can be used to open an airway blocked by abnormal tissue.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

After small cell lung cancer has been diagnosed, tests are done to find out if cancer cells have spread within the chest or to other parts of the body.

The process used to find out if cancer has spread within the chest or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. Some of the tests used to diagnose small cell lung cancer are also used to stage the disease. (See the General Information section.) Other tests and procedures that may be used in the staging process include the following:

• Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.
• Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
• MRI (magnetic resonance imaging) of the brain: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography. EUS may be used to guide fine-needle aspiration (FNA) biopsy of the lung, lymph nodes, or other areas.
• Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells.
• Radionuclide bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.

The following stages are used for small cell lung cancer:

Limited-Stage Small Cell Lung Cancer
In limited-stage, cancer is found in one lung, the tissues between the lungs, and nearby lymph nodes only.

Extensive-Stage Small Cell Lung Cancer
In extensive-stage, cancer has spread outside of the lung in which it began or to other parts of the body.

Tests and procedures that examine the lungs are used to detect (find), diagnose, and stage small cell lung cancer.

The following tests and procedures may be used:

Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

CT scan (CAT scan) of the brain, chest, and abdomen: A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

Sputum cytology: A microscope is used to check for cancer cells in the sputum (mucus coughed up from the lungs).

Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.

Fine-needle aspiration (FNA) biopsy of the lung: The removal of tissue or fluid from the lung using a thin needle. A CT scan, ultrasound, or other imaging procedure is used to locate the abnormal tissue or fluid in the lung. A small incision may be made in the skin where the biopsy needle is inserted into the abnormal tissue or fluid. A sample is removed with the needle and sent to the laboratory. A pathologist then views the sample under a microscope to look for cancer cells. A chest x-ray is done after the procedure to make sure no air is leaking from the lung into the chest.

Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs, and a thoracoscope is inserted into the chest. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer. In some cases, this procedure is used to remove part of the esophagus or lung. If certain tissues, organs, or lymph nodes can’t be reached, a thoracotomy may be done. In this procedure, a larger incision is made between the ribs and the chest is opened.

Thoracentesis: The removal of fluid from the space between the lining of the chest and the lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells.

There are two types of small cell lung cancer.

These two types include many different types of cells. The cancer cells of each type grow and spread in different ways. The types of small cell lung cancer are named for the kinds of cells found in the cancer and how the cells look when viewed under a microscope:

• Small cell carcinoma (oat cell cancer).
• Combined small cell carcinoma.

Smoking tobacco is the major risk factor for developing small cell lung cancer.

Visit the National Cancer Institute where this information and more can be found about Small Cell Lung Cancer or ask your cancer care team questions about your individual situation.

Lo que usted necesita saber sobre el cáncer de pulmón de células pequeñas.

Occult Non-Small Cell Lung Cancer

Treatment of occult non-small cell lung cancer depends on where the cancer has spread. It can usually be cured by surgery.

Stage 0
Treatment of stage 0 may include the following:

• Surgery (wedge resection or segmental resection).
• Photodynamic therapy using an endoscope.
• Electrocautery, cryosurgery, or laser surgery using an endoscope.

Stage I
Treatment of stage I non-small cell lung cancer may include the following:

• Surgery (wedge resection, segmental resection, sleeve resection, or lobectomy).
• External radiation therapy (for patients who cannot have surgery or choose not to have surgery).
• A clinical trial of surgery followed by chemoprevention.

Stage II
Treatment of stage II non-small cell lung cancer may include the following:

• Surgery (wedge resection, segmental resection, sleeve resection, lobectomy, or pneumonectomy).
• External radiation therapy (for patients who cannot have surgery or choose not to have surgery).
• Surgery followed by chemotherapy.

Stage III
Treatment of stage IIIA non-small cell lung cancer that can be removed with surgery may include surgery followed by chemotherapy.

Treatment of stage IIIA non-small cell lung cancer that cannot be removed with surgery may include the following:

• Chemotherapy combined with radiation therapy.
• External radiation therapy alone (for patients who cannot be treated with combined therapy).

Some stage IIIA non-small cell lung tumors that have grown into the chest wall may be completely removed. Treatment of chest wall tumors may include the following:

• Surgery.
• Surgery and radiation therapy.
• Radiation therapy alone.
• Chemotherapy combined with radiation therapy and/or surgery.

Treatment of stage IIIB non-small cell lung cancer may include the following:

• Chemotherapy combined with external radiation therapy.
• External radiation therapy as palliative therapy, to relieve pain and other symptoms and improve the quality of life.

Stage IV
Treatment of stage IV non-small cell lung cancer may include the following:

• External radiation therapy as palliative therapy, to relieve pain and other symptoms and improve the quality of life.
• Combination chemotherapy.
• Combination chemotherapy and targeted therapy.
• Laser therapy and/or internal radiation therapy using an endoscope.

After lung cancer has been diagnosed, tests are done to find out if cancer cells have spread within the lungs or to other parts of the body.

• Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells.
• Mediastinoscopy: A surgical procedure to look at the organs, tissues, and lymph nodes between the lungs for abnormal areas. An incision (cut) is made at the top of the breastbone and a mediastinoscope is inserted into the chest. A mediastinoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer.
• Anterior mediastinotomy: A surgical procedure to look at the organs and tissues between the lungs and between the breastbone and heart for abnormal areas. An incision (cut) is made next to the breastbone and a mediastinoscope is inserted into the chest. A mediastinoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer. This is also called the Chamberlain procedure.

Occult (hidden) stage
In the occult (hidden) stage, cancer cells are found in sputum (mucus coughed up from the lungs), but no tumor can be found in the lung by imaging or bronchoscopy, or the primary tumor is too small to be checked.

Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the innermost lining of the lung. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I
In stage I, cancer has formed. Stage I is divided into stages IA and IB:

• Stage IA: The tumor is in the lung only and is 3 centimeters or smaller.
• Stage IB: One or more of the following is true:
  • The tumor is larger than 3 centimeters.
  • Cancer has spread to the main bronchus of the lung, and is at least 2 centimeters from the carina (where the trachea joins the bronchi).
  • Cancer has spread to the innermost layer of the membrane that covers the lungs.
  • The tumor partly blocks the bronchus or bronchioles and part of the lung has collapsed or developed pneumonitis (inflammation of the lung).

Stage II
Stage II is divided into stages IIA and IIB:

• Stage IIA: The tumor is 3 centimeters or smaller and cancer has spread to nearby lymph nodes on the same side of the chest as the tumor.
• Stage IIB:
  • Cancer has spread to nearby lymph nodes on the same side of the chest as the tumor and one or more of the following is true:
    • The tumor is larger than 3 centimeters.
    • Cancer has spread to the main bronchus of the lung and is 2 centimeters or more from the carina (where the trachea joins the bronchi).
    • Cancer has spread to the innermost layer of the membrane that covers the lungs.
    • The tumor partly blocks the bronchus or bronchioles and part of the lung has collapsed or developed pneumonitis (inflammation of the lung).

or

• Cancer has not spread to lymph nodes and one or more of the following is true:
  • The tumor may be any size and cancer has spread to the chest wall, or the diaphragm, or the pleura between the lungs, or membranes surrounding the heart.
  • Cancer has spread to the main bronchus of the lung and is no more than 2 centimeters from the carina (where the trachea meets the bronchi), but has not spread to the trachea.
  • Cancer blocks the bronchus or bronchioles and the whole lung has collapsed or developed pneumonitis (inflammation of the lung).

Stage III

In stage IIIA, cancer has spread to lymph nodes on the same side of the chest as the tumor. Also:

• The tumor may be any size.
• Cancer may have spread to the main bronchus, the chest wall, the diaphragm, the pleura around the lungs, or the membrane around the heart, but has not spread to the trachea.
• Part or all of the lung may have collapsed or developed pneumonitis (inflammation of the lung).

In stage IIIB, the tumor may be any size and has spread:

• To lymph nodes above the collarbone or in the opposite side of the chest from the tumor; and/or
• To any of the following:
  • Heart.
  • Major blood vessels that lead to or from the heart.
  • Chest wall.
  • Diaphragm.
  • Trachea.
  • Esophagus.
  • Sternum (chest bone) or backbone.
  • More than one place in the same lobe of the lung.
  • The fluid of the pleural cavity surrounding the lung.

Stage 4
In stage IV, cancer may have spread to lymph nodes and has spread to another lobe of the lungs or to other parts of the body, such as the brain, liver, adrenal glands, kidneys, or bone.

The process used to find out if cancer has spread within the lungs or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. Some of the tests used to diagnose non-small cell lung cancer are also used to stage the disease.  Other tests and procedures that may be used in the staging process include the following:

• Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the brain. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Radionuclide bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
• Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography. EUS may be used to guide fine needle aspiration (FNA) biopsy of the lung, lymph nodes, or other areas.

There are several types of non-small cell lung cancer.

Each type of non-small cell lung cancer has different kinds of cancer cells. The cancer cells of each type grow and spread in different ways. The types of non-small cell lung cancer are named for the kinds of cells found in the cancer and how the cells look under a microscope:

• Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that look like fish scales. This is also called epidermoid carcinoma.
• Large cell carcinoma: Cancer that may begin in several types of large cells.
• Adenocarcinoma: Cancer that begins in the cells that line the alveoli and make substances such as mucus.

Other less common types of non-small cell lung cancer are: pleomorphic, carcinoid tumor, salivary gland carcinoma, and unclassified carcinoma.

Smoking can increase the risk of developing non-small cell lung cancer.

Visit the National Cancer Institute where this information and more can be found about Non-Small Cell Lung Cancer or ask your cancer care team questions about your individual situation.

Lo que usted necesita saber sobre el cáncer de pulmón de células no pequeñas.

If the diagnosis is melanoma, the doctor needs to learn the extent, or stage, of the disease before planning treatment. Staging is a careful attempt to learn how thick the tumor is, how deeply the melanoma has invaded the skin, and whether melanoma cells have spread to nearby lymph nodes or other parts of the body. The doctor may remove nearby lymph nodes to check for cancer cells. (Such surgery may be considered part of the treatment because removing cancerous lymph nodes may help control the disease.) The doctor also does a careful physical exam and, if the tumor is thick, may order chest x-rays, blood tests, and scans of the liver, bones, and brain.

The following stages are used for melanoma:

• Stage 0: In stage 0, the melanoma cells are found only in the outer layer of skin cells and have not invaded deeper tissues.
• Stage I: Melanoma in stage I is thin:
  • The tumor is no more than 1 millimeter (1/25 inch) thick. The outer layer (epidermis) of skin may appear scraped. (This is called an ulceration).
  • Or, the tumor is between 1 and 2 millimeters (1/12 inch) thick. There is no ulceration. The melanoma cells have not spread to nearby lymph nodes.
• Stage II: The tumor is at least 1 millimeter thick:
  • The tumor is between 1 and 2 millimeters thick. There is ulceration.
  • Or, the thickness of the tumor is more than 2 millimeters. There may be ulceration. The melanoma cells have not spread to nearby lymph nodes.
• Stage III: The melanoma cells have spread to nearby tissues:
  • The melanoma cells have spread to one or more nearby lymph nodes.
  • Or, the melanoma cells have spread to tissues just outside the original tumor but not to any lymph nodes.
• Stage IV: The melanoma cells have spread to other organs, to lymph nodes, or to skin areas far away from the original tumor.
• Recurrent: Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may have come back in the original site or in another part of the body.